manufacturing articles and methods for treatment using adoptive cell therapy

专利摘要:
Adoptive cell therapy methods are provided that involve administering doses of cells for the treatment of diseases and conditions, including certain B-cell malignancies. Cells generally express recombinant receptors, such as chimeric antigen receptors (RAQs). In some modalities, the methods are for treating individuals with non-Hodgkin's lymphoma (NHL). In some modalities, the methods are for the treatment of individuals with relapsed or refractory NHL. Manufacturing articles and prophylactic treatments are also provided in connection with adoptive therapy methods.
公开号:BR112019025403A2
申请号:R112019025403-0
申请日:2018-06-01
公开日:2020-08-18
发明作者:Tina Albertson；Clinton WEBER；Christopher Glen RAMSBORG；Brian CHRISTIN；Jacob Randolph GARCIA；Claire L. SUTHERLAND；Rachel K. YOST
申请人:Juno Therapeutics Inc；
IPC主号:

专利说明:

[001] [001] This application claims priority of US provisional application No. 62 / 514,774, filed on June 2, 2017, entitled "ARTICLES OF MANUFACTURE AND METHODS FOR TREATMENT USING ADOPTIVE CELL THERAPY", provisional application US No. 62 / 515,530, filed on June 5, 2017, entitled "ARTICLES
[002] [002] This application is being filed together with a Sequence Listing in electronic format. The Sequence Listing is provided as a file titled 735042012140SedqList.txt, created on June 1, 2018, with a size of 35,306 bytes. The information in the electronic format of the Sequence Listing is incorporated by reference in its entirety. Field
[003] [003] The present description relates, in some respects, to adoptive cell therapy involving the administration of doses of cells for the treatment of individuals with diseases and conditions, such as certain malignant B-cell diseases, and related methods, compositions, uses and articles of manufacture. The cells express recombinant receptors, such as chimeric antigen receptors (RAQs). In some embodiments, the disease or condition is non-Hodgkin's lymphoma (NHL), such as relapsed or refractory NHL or specific NHL subtype; in some modalities, the individual is from a specific group or subset of individuals with NHL, such as heavily pretreated individuals or with poor prognosis. Background
[004] [004] Various methods of immunotherapy and / or cell therapy are available for the treatment of diseases and conditions. For example, adoptive cell therapies (including those that involve the administration of expression cells of specific chimeric receptors for a disease or disorder of interest, such as chimeric antigen receptors (RAQs) and / or other recombinant antigen receptors, as well as other cells adoptive immune systems and adoptive T cell therapies) can be beneficial in the treatment of cancer or other diseases or disorders. Improved approaches are needed. Methods and uses are provided that meet these needs. summary
[005] [005] Here are provided methods, uses, compositions, formulations and articles of manufacture for the treatment of individuals having or suspected of having a disease or illness, such as a cancer or tumor, optionally a B-cell malignancy, such as NHL or LLA or LLC or a subtype thereof. The methods and other modalities generally relate to the administration of the T cells in question, generally modified T cells, such as those that express or contain a recombinant receptor, such as a chimeric antigen (RAQ) or TCR receptor.
[006] [006] In some modalities, the dose of cells or cells administered in connection with any modalities of the methods, compositions, articles of manufacture and uses provided, contains CD4 * T cells or a subtype or phenotype thereof (such as CD4 * T cells of modified or recombinant receptor expression) and / or CD8 * T cells or a subtype thereof (such as modified or recombinant receptor expression CD4 * cells). In some embodiments, CD8 * cells or subtype or phenotype are present in a particular dose or quantity or number; in some embodiments, CD4 * cells or subtype or phenotype are present in a particular dose or quantity or number. In some embodiments, CD8 * cells or subtype or phenotype of the same and CD4 * cells or subtype or phenotype of the same, are present in the article or composition or combination, or are administered in the methods, in a defined relationship, as in or in around 1: 1 or between or about 1: 3 and in or about 3: 1. In some embodiments, the dose or administration contains or is of a particular quantity or number of a population of cells and the ratio is a ratio defined or is a naturally occurring relationship, as in the blood of the individual from which the cells are derived, or a relationship that occurs without selection or control for a particular relationship.
[007] [007] In some embodiments, CD4 * T cells (or a subset of them) and CD8 * T cells (or a subset of them), individually, contain a receptor that specifically binds to a target antigen expressed by the disease or condition, or the a cell or tissue of the same and / or that is associated with the disease or condition.
[008] [008] In some embodiments, CD4 * and CD8 * cells are administered and / or formulated together, for example, in a single formulation and / or from a single container.
[009] [009] In some embodiments, separate administrations of CD4 * and CD8 * cells are performed at the dose and / or separate “formulations or containers are included, each individually enriched for CD4 * cells or modified CD4 * cells (as a formulation containing at least a certain percentage of, for example, at least 80%, 85%, 90% or 95% or more of CD4 * cells and / or not comprising more than 10% or more than 5% of CD8 T cells *) and CD8 * cells or modified CD8 * cells (as a formulation containing at least a certain percentage of, for example, at least 80%, 85%, 90% or 95% or more of CD8 * cells and / or not comprising more than 10% or more than 5% CD4 T cells *).
[0010] [0010] In some respects, administration comprises administering a plurality of separate compositions, said plurality of separate compositions comprising a first composition comprising one of the CD4 * T cells and CD8 * T cells and a second composition comprising the another of the CD4 * T cells and the CD8 * T cells. In certain embodiments of any of the methods provided, the receptor contained by CD4 * T cells and / or the receptor contained by CD8 * T cells comprises T cells, a recombinant receptor and / or in which CD4 * T cells and / or T cells CD8 * are genetically modified to express the receptor.
[0011] [0011] In some modalities of any of the provided modalities, the administration of the first composition and the administration of the second composition are carried out on the same day, are carried out between about 0 and about 12 hours separately, between about 0 and about 6 hours separately or between 0 and 2 hours separately; and / or the start of administration of the first composition and the start of administration of the second composition are carried out between about 1 minute and about 1 hour separately or between about 5 minutes and about 30 minutes separately. In certain embodiments of any of the methods provided, the first composition and the second composition are administered no more than 2 hours, no more than 1 hour, no more than 30 minutes, no more than 15 minutes, no more than 10 minutes or no more than 5 minutes separately.
[0012] [0012] In certain embodiments of any of the provided modalities, the first composition comprises CD4 * T cells. In some embodiments of any of the methods provided, the first composition comprises CD8 * T cells. In particular embodiments of any of the methods provided, the first composition is administered before the second composition is administered. In certain embodiments of any of the methods provided, the cell dose comprises a defined ratio of CD4 * cells that express a recombinant receptor for CD8 * cells that express a recombinant receptor and / or CD4 * cells for CD8 * cells, whose ratio is optionally it is either approximately 1: 1 or between approximately 1: 3 and approximately 3: 1; and / or CD4 * T cells comprising the receptor in one of the first and second compositions and CD8 * T cells comprising the receptor in the other of the first and second compositions are present in a defined relationship, the relationship of which is optionally or approximately 1: 1 or is between approximately 1: 3 and approximately 3: 1; and / or CD4 * T cells comprising the receptor and CD8 * T cells comprising the receptor administered in the first and second compositions are present in a defined ratio, the ratio of which is optionally either approximately 1: 1 or between approximately 1: 3 and approximately 3: 1. In some embodiments of any of the methods provided, the defined ratio is or is approximately 1: 1. In particular embodiments of any of the provided methods, the dose of T cells is administered to the individual as a single dose or is administered only once within a period of two weeks, one month, three months, six months, 1 year or more. In certain embodiments of any of the methods provided, the dose of T cells is administered as a double dose, comprising a first dose of T cells and a consecutive dose of T cells, where one or both of the first dose and the second dose comprises ( m) administering the plurality of T cell compositions. In some embodiments of any of the methods provided, the consecutive dose is administered at a point in time that is at least or more than about 7 days or 14 days after and less than about 28 days after starting the first dose of cells.
[0013] [0013] In particular embodiments of any of the methods or embodiments provided, the cell dose comprises between or about 1 X 10º and the or about 5 x 10º T cells of total recombinant receptor expression or total T cells, between or about 1 x 10º and to or about 1 x 10º total recombinant receptor expression T cells or total T cells, between or about 5x 10º and to or about 1 x 107 total recombinant receptor expression T cells or cells Total T, or from or about 1 x 10 to 1 x 10 7 total recombinant receptor expression T cells or total T cells, each inclusive. In certain embodiments of any of the methods provided, the dose of T cells comprises the administration of no more than 1 x 10 th total recombinant receptor expression T cells or total T cells, not more than 1 x 107 T cells for total recombinant receptor or total T cells, not more than 0.5 x 107 total recombinant receptor expression T cells or total T cells, not more than 1 x 10th total recombinant receptor expression T cells or total T cells, no more than 0.5 x 10 th total recombinant receptor expression T cells or total T cells. In some embodiments of any of the methods provided, the dose of T cells comprises between about 5 x 10 ”recombinant receptor expression T cells and 1 x 10 ° recombinant receptor expression T cells, each inclusive.
[0014] [0014] In particular embodiments of any of the methods provided, the recombinant receptor specifically binds to an antigen associated with the disease or condition or expressed in cells of the environment of an injury associated with the disease or condition. In certain modalities of any of the methods provided, the disease or condition is a cancer. In some modalities of any of the methods provided, the disease or condition is a myeloma, leukemia or lymphoma. In particular modalities of any of the methods provided, the antigen is ROR1, B cell maturation antigen (BCMA), carbonic anhydrase 9 (CAIX), tEGFR, Her2 / neu (erbB2 receptor tyrosine kinase), LI-CAM, CD19, CD20 , CD22, mesothelin, CEA and hepatitis B surface antigen, antifolate receptor, CD23, CD24, CD30, CD33, CD38, CD44, EGFR, epithelial glycoprotein 2 (GEP-2), epithelial glycoprotein 40 (GEP-40), EPHa2 , erb-B2, erb-B3, erb-B4, erbB dimers, EGFR vlll, folate-binding protein (FBP), FOCRL5, FORH5, fetal acetylcholine receptor, GD2, GD3, HMW-MAA, IL-22R- alpha, IL-13R-alpha2, kinase insertion domain receptor (kdr), kappa light chain, Lewis Y, L1 cell adhesion molecule, (LI-CAM), melanoma-associated antigen (MAGE) -A1, MAGE -A3, MAGE-A6, preferably melanoma expressed antigen (AMEPE), survivin, TAG72, B7-H6, IL-13 2 alpha receptor (IL-13Ra2), CA9, GD3, HMW-MAA, CD171, G250 / CAIX , HLA-AI MAGE Al, HLA-A2 NY-ESO-1, PSCA, receptor-a of folate, CD44v6, CD44v7 / 8, integrin avb6, 8H9, NCAM, VEGF receptors, 574, AchR Fetal, NKG2D ligands, CD44v6, dual antigen, testicular cancer antigen, mesothelin, murine CMV, mucin 1 (MUC1) , MUC16, PSCA, NKG2D, NY-ESO-1, MART-1, gp100, oncofetal antigen, ROR1, TAG72, VEGF-R2, carcinoembryonic antigen (CEA), Her2 / neu, estrogen receptor, progesterone receptor, ephrinB2, CD123, c-Met, GD-2, O-acetylated GD2 (GD20), CE7, Wilms' Tumor 1 (WT-1), a cyclin, cyclin A2, CCL-1, CD138, G 5D Protein Coupled Receptor (RAPG5D ) or a pathogen specific antigen. In certain modalities of any of the methods provided, the antigen is CD19.
[0015] [0015] In some modalities of any of the methods provided, the disease or condition is a B-cell malignancy and / or is acute lymphoblastic leukemia (ALL), adult ALL, chronic lymphoblastic leukemia (LLC), non-Hodgkin's lymphoma (NHL) and Lymphoma
[0016] [0016] In some embodiments of any of the methods provided, the recombinant receptor includes an extracellular domain containing an antigen-binding domain. In some embodiments, the antigen-binding domain is or includes an antibody or antibody fragment thereof, which optionally is a single chain fragment. In particular embodiments of any of the methods provided, the fragment includes variable regions of antibody joined by a flexible linker. In some embodiments, the fragment includes an scFv. In some embodiments of any of the methods provided, the recombinant receptor also includes a spacer and / or a hinge region.
[0017] [0017] In certain embodiments of any of the methods provided, the recombinant receptor includes an intracellular signaling region. In some embodiments of any of the methods provided, the intracellular signaling region includes an intracellular signaling domain. In some embodiments of any of the methods provided, the intracellular signaling domain is or includes a primary signaling domain, a signaling domain that is capable of inducing a primary activation signal in a T cell, a signaling domain of a component of the T cell receptor
[0018] [0018] In particular embodiments of any of the methods provided, the recombinant receptor also includes a transmembrane domain disposed between the extracellular domain and the intracellular signaling region.
[0019] [0019] In some embodiments of any of the methods provided, the intracellular signaling region also includes a co-stimulating signaling region. In some embodiments, the co-stimulatory signaling region includes an intracellular signaling domain of a T-cell co-stimulating molecule or a signaling portion thereof. In certain embodiments of any of the methods provided, the co-stimulatory signaling region includes an intracellular signaling domain of a CD28, a 4-1BB or an ICOS or a signaling portion thereof. In some embodiments, the co-stimulating signaling region is between the transmembrane domain and the intracellular signaling region.
[0020] [0020] In certain embodiments of any of the methods provided, the recombinant receptor is a chimeric antigen (RAQ) receptor, optionally wherein the recombinant receptor is a chimeric antigen (RAQ) receptor, optionally where the RAQ comprises a domain of recognition of extracellular antigen that specifically binds to the antigen and an intracellular signaling domain comprising an ITAM, wherein, optionally, the intracellular signaling domain comprises an intracellular domain of a CD3-zeta (CD36) chain; and / or wherein the RAQ further comprises a co-stimulating signaling region, which optionally comprises a CD28 or 4-1BB signaling domain.
[0021] [0021] In some embodiments, articles of manufacture include a container such as a vial containing a composition comprising CD4 * T cells expressing a recombinant receptor and instructions for administering, to an individual having a disease or condition, the cell composition CD4 * T as a plurality of compositions with a composition comprising CD8 * T cells expressing a recombinant receptor or unit dose of cells comprising all or a portion of the plurality of CD4 * T cells and a composition comprising CD8 * T cells which express a recombinant receptor. In some embodiments, the article of manufacture includes a container such as a vial containing a composition comprising CD8 * T cells expressing a recombinant receptor and instructions for administering, to an individual having a disease or condition, the CD8 * T cell composition * as a plurality of compositions with a composition comprising CD4 * T cells expressing a recombinant receptor or a unit dose of cells comprising all or a portion of the plurality of CD4 * T cells and a composition comprising CD8 * T cells expressing a receptor recombinant.
[0022] [0022] In some of the modalities, the RAQ comprises, in order, the RAQ includes an antigen-specific scFv, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulating molecule, y which optionally is or comprises a 4-1BB , and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which is optionally or comprises a CD3zeta signaling domain and, optionally, further includes a spacer between the transmembrane domain and the scFv;
[0023] [0023] In some of any of the modalities, the RAQ includes, in order, an antigen-specific scFv, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulating molecule, which optionally is or comprises a 4- signaling domain 1BB, and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which is optionally a CD3zeta signaling domain.
[0024] [0024] In some of any of the modalities, the RAQ comprises or consists of, in order, an antigen-specific scFv, a spacer, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulating molecule, which is optionally a domain 4-1BB signaling and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which optionally is or comprises a CD3zeta signaling domain.
[0025] [0025] In some respects, the spacer is a polypeptide spacer that (a) comprises or consists of all or a portion of an immunoglobulin joint or a modified version thereof or comprises about 15 amino acids or less, and does not comprise a region extracellular CD28 or an extracellular CD8 region, (b) comprises or consists of all or a portion of an immunoglobulin joint, optionally an | IgG4 joint or a modified version of it and / or comprises about 15 amino acids or less and does not comprise an extracellular region of CD28 or an extracellular region of CD8, or (c) is either about 12 amino acids in length and / or comprises or consists of all or a portion of an immunoglobulin joint, optionally an IgG4, or an modified version of it; or (d) has or consists of the sequence of SEQ ID NO: 1, a sequence encoded by SEQ ID NO: 2, SEQ ID NO: 30, SEQ ID NO: 31, SEQ ID NO: 31, SEQ ID NO: 32, SEQ ID NO: 33, SEQ ID NO: 34, or a variant of any of the above having at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94 %, 95%, 96%, 97%, 98%, 99% or more of their sequence identity, or (e) comprises or consists of the formula X1PPX2P, where X :; is glycine, cysteine or arginine and X> is cysteine or threonine; and / or the co-stimulatory domain comprises SEQ ID NO: 12 or a variant thereof with at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94% , 95%, 96%, 97%, 98%, 99% or more sequence identity; and / or the primary signaling domain comprises SEQ ID NO: 13 or 14 or 15 or a variant thereof having at least 85%, 86%, 87%, 88%, 89%, 89%, 90%, 91% , 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more of sequence identity; and / or scFv comprises a CDRL1 sequence of RASQDISKYLN (SEQ ID NO: 35), a CDRL2 sequence of SRLHSGV (SEQ ID NO: 36) and / or a CDRL3 sequence of GNTLPYTFG (SEQ ID NO: 37) and / or a DYGVS CDRH1 sequence (SEQ ID NO: 38), a VIWGSETTYYNSALKS CDRH2 sequence (SEQ ID NO: 39) and / or a YAMDYWG CDRH3 sequence (SEQ ID NO: 40) or where scFv comprises an FMC63 heavy chain variable region and an FMC63 light chain variable region and / or an FMC63 CDRL1 sequence, an FMC63 CDRL2 sequence, an FMC63 CDRL3 sequence, an FMC63 CDRH1 sequence, an FMC63 CDRH2 sequence and FMC63 CDRH3 sequence either bind to the same epitope or compete for binding with any of the above, and optionally where scFv comprises, in order, a Vn, a linker, optionally comprising SEQ ID NO: 24 and a V. and / or scFv comprises a flexible linker and / or comprises the amino acid sequence mentioned as SEQ ID NO: 24.
[0026] [0026] In some embodiments, the spacer comprises or consists of SEQ ID NO: 1, the co-stimulator domain comprises SEQ ID NO: 12 or a variant thereof having at least 85%, 86%, 87%, 88%, 89% , 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more sequence identity thereof, the transmembrane domain is CD28 or comprises SEQ ID NO : 9 or a variant thereof having at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97% , 98%, 99% or more sequence identity thereof, the scFv contains the binding domain of or CDRs or Vx and Vi of FMC63, the primary signaling domain contains SEQ ID NO: 13, 14 or 15 and / or a variant of the same with at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99 % or more of the same sequence identity.
[0027] [0027] In some embodiments, the spacer comprises or consists of SEQ ID NO: 30, the co-stimulator domain comprises SEQ ID NO: 12 or a variant thereof having at least 85%, 86%, 87%, 88%, 89% , 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more sequence identity thereof, the transmembrane domain is CD28 or comprises SEQ ID NO : 9 or a variant thereof having at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more of the same sequence identity, scFv contains the binding domain of or CDRs of either Vu and Vi of FMC63, the primary signaling domain contains SEQ ID NO: 13, 14 or 15 and / or a variant of the same with at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99 % or more of the same sequence identity.
[0028] [0028] In some embodiments, the spacer comprises or consists of SEQ ID NO: 31, the co-stimulator domain comprises SEQ ID NO: 12 or a variant thereof having at least 85%, 86%, 87%, 88%, 89% , 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more sequence identity thereof, the transmembrane domain is CD28 or comprises SEQ ID NO : 9 or a variant thereof having at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97% , 98%, 99% or more of the same sequence identity, the scFv contains the binding domain of or CDRs of or Vxn and Vi. of FMC63, the primary signaling domain contains SEQ ID NO: 13, 14 or 15 and / or a variant thereof with at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more of the same sequence identity.
[0029] [0029] In some embodiments, the spacer comprises or consists of SEQ ID NO: 33, the co-stimulator domain comprises SEQ ID NO: 12 or a variant thereof having at least 85%, 86%, 87%, 88%, 89% , 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more sequence identity thereof, the transmembrane domain is CD28 or comprises SEQ ID NO : 9 or a variant thereof having at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97% , 98%, 99% or more sequence identity thereof, scFv contains the binding domain of or CDRs of or VH and Vi of FMC63, the primary signaling domain contains SEQ ID NO: 13, 14 or 15 and / or a variant thereof having at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 96%, 97%, 98%, 99%
[0030] [0030] In some embodiments, the spacer comprises or consists of SEQ ID NO: 34, the co-stimulator domain comprises SEQ ID NO: 12 or a variant thereof having at least 85%, 86%, 87%, 88%, 89% , 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more sequence identity thereof, the transmembrane domain is CD28 or comprises SEQ ID NO : 9 or a variant thereof having at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97% , 98%, 99% or more sequence identity thereof, the scFv contains the binding domain of or CDRs of or Viu and Vi of FMC63, the primary signaling domain contains SEQ ID NO: 13, 14 or 15 and / or a variant thereof having at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more of the same sequence identity.
[0031] [0031] In some embodiments of any of the articles of manufacture supplied, the recombinant receptor expressed by CD4 * cells and the recombinant receptor expressed by CD8 * T cells are the same or different. In particular embodiments of any of the articles of manufacture supplied, the vial contains more than or more than about 10 x 10 T cells or recombinant receptor expression T cells, more than or more than about 15 x 10 T cells or expression T cells of recombinant receptor, more than or more than about 25 x 10th T cells or T cells of recombinant receptor expression.
[0032] [0032] In certain embodiments of any of the manufactured articles supplied, the vial contains between about 10 million cells per ml and about 70 million cells per ml, between about 10 million cells per ml and about 50 million of cells per ml, between about 10 million cells per ml and about millions of cells per ml, between about 10 million cells per ml and about 15 million cells per ml, 15 million cells per ml and about of 70 million cells per ml, between about 15 million cells per ml and about 50 million cells per ml, between about 15 million cells per ml and about 25 million cells per ml, between about 25 million cells per ml! and about 70 million cells per ml, between about 25 million cells per ml and about 50 million cells per ml and between about 50 million cells per ml and about 70 million cells per ml. In some embodiments of any of the articles of manufacture provided, the composition further comprises a cryoprotectant and / or the article further includes instructions for defrosting the composition prior to administration to the individual.
[0033] [0033] In some embodiments of any of the articles of manufacture provided, the compositions or plurality of compositions comprise a dose of cells comprising from or about 2 x 107 to about 4 x 107 CD8 cells *, such as about 2 x 10 °. , 2.5x 107, 3 x 107, 3.5 x 107 or 4 x 107 CD8 * cells and from or about 2 x 107 to about 4 x 10 ”CD4 * cells, such as about 2 x 107, 2 , 5 x 107, 3 x 107, 3.5 x 107, or 4 x 107 CD4 cells *, each inclusive. In some embodiments, the compositions or plurality of compositions comprise a dose of cells comprising approximately 3 x 10 7 CD8 * cells and 3.5 x 10 7 CD4 * cells.
[0034] [0034] In particular embodiments of any of the articles of manufacture provided, the plurality of cell compositions comprises a defined ratio of CD4 * cells that express the recombinant receptor to CD8 * cells that express the recombinant receptor and / or CD4 * cells for CD8 * cells, the ratio of which is optionally approximately 1: 1 or between approximately 1: 3 and approximately 3: 1. In certain embodiments of any of the manufactured articles provided, the defined ratio is or is approximately 1: 1. In some embodiments of any of the articles of manufacture provided, the plurality of compositions collectively comprises a dose of cells comprising from or about 1 x 10 to 5 x 108 total recombinant receptor expression T cells or total T cells, 1 x 10 to 1 x 108 total recombinant receptor expression T cells or total T cells, from or about 5 x 10º to 1 x 107 total recombinant receptor expression T cells or total T cells, or from or about 1 x 10 th to 1 x 107 total recombinant receptor expression T cells or total T cells, each inclusive. In particular embodiments of any of the articles of manufacture provided, the plurality of compositions collectively comprise a dose of cells comprising no more than 1 x 10 th total recombinant receptor expression T cells or total T cells, no more than 1 x 10 ”total recombinant receptor expression T cells or total T cells, not more than 0.5 x 107 total recombinant receptor expression T cells or total T cells, not more than 1 x 10º receptor expression T cells total recombinant or total T cells, no more than 0.5 x 10 th total recombinant receptor expression T cells or total T cells. In certain embodiments of any of the articles of manufacture provided, the plurality of compositions collectively comprise a dose of cells comprising between or about 5 x 107 recombinant receptor expression T cells and 1 x 108 recombinant receptor expression T cells, each including.
[0035] [0035] In some embodiments of any of the manufactured articles provided, the instructions specify the administration of the composition comprising CD4 * T cells and the composition comprising CD8 * T cells with O to 12 hours separately, O to
[0036] [0036] In particular embodiments of any of the manufactured articles provided, the recombinant receptor specifically binds to an antigen associated with the disease or condition or expressed in the cells of the environment of an injury associated with the disease or condition. In certain embodiments of any of the manufactured articles provided, the disease or condition is a cancer. In some embodiments of any of the manufactured articles provided, the disease or condition is a myeloma, leukemia or lymphoma.
[0037] [0037] In particular modalities of any of the manufactured articles provided, the antigen is ROR1, B cell maturation antigen (BCMA), carbonic anhydrase 9 (CAIX), tEGFR, Her2 / neu (erbB2 receptor tyrosine kinase), LI- CAM, CD19, CD20, CD 22, mesothelin, CEA and hepatitis B surface antigen, antifolate receptor, CD23, CD24, CD30, CD33, CD38, CD44, EGFR, epithelial glycoprotein 2 (GEP-2), epithelial glycoprotein 40 (EPG-40), EPHa 2, erb-B2, erb-B3, erb-B4, erbB, EGFR villl, folate-binding protein (FBP), FCRL5, FOCRHS5, fetal acetylcholine receptor, GD2, GD3, HMW-MAA, IL-22R-alpha, IL-13R-alpha2, kinase insertion domain receptor (kdr), kappa light chain, Lewis Y, L1 cell adhesion molecule, (LI-CAM), antigen associated with melanoma (MAGE) -A1, MAGE-A3, MAGE-AS6, preferably expressed melanoma antigen (AMEPE), survivin, TAG72, B7-H6, I1L-13 alpha-13 receptor (IL-13Ra2), CA9, GD3, HMW-MAA, CD171, G250 / CAIX, HLA-AI MAGE Al, HLA-A2 NY-E SO-1, PSCA, folate receptor-a, CD44v6, CD44v7 / 8, integrin avb6, 8H9, NCAM, VEGF receptors, 574, AchR fetal, NKG2D ligands, CD44v6, dual antigen, testicular cancer antigen, mesothelin, Murine CMV, mucin 1 (MUC1), MUC16, PSCA, NKG2D, NY-ESO-1, MART-1, gp100, oncofetal antigen, ROR1, TAG72, VEGF-R2, carcinoembryonic antigen (CEA), Her2 / neu, receptor estrogen receptor, progesterone receptor, ephrinB2, CD123, c-Met, GD-2, O-acetylated GD2 (OGD2), CE7, Wilms' tumor 1 (WT-1), a cyclin, cyclin A2, CCL-1, CD138 , Receptor Coupled to Protein G 5D (RAPG5D) or a pathogen specific antigen. In certain modalities of any of the manufactured articles provided, the antigen is CD19.
[0038] [0038] In some embodiments of any of the manufactured articles provided, the disease or condition is a B-cell malignancy and / or is acute lymphoblastic leukemia (ALL), adult ALL, chronic lymphoblastic leukemia (LLC), non-Hodgkin's lymphoma ( NHL) and diffuse large B cell lymphoma (LDGCB). In particular modalities of any of the articles of manufacture supplied, the disease or condition is NHL and NHL is selected from the group consisting of aggressive NHL, diffuse large B cell lymphoma (LDGCB), NOS (again and transformed into indolent), primary mediastinal B-cell lymphoma (LCBMP), T-cell / histocyte-rich B-cell lymphoma (LCBRCTH), Burkitt's lymphoma,
[0039] [0039] In certain embodiments of any of the manufactured articles provided, T cells are primary T cells obtained from an individual. In some embodiments of any of the manufactured articles provided, T cells are autologous to the individual. In particular embodiments of any of the manufactured articles supplied, T cells are allogeneic to the individual.
[0040] [0040] In certain embodiments of any of the articles of manufacture provided, the recombinant receptor is or includes a functional non-RCT antigen receptor or an RCT or its antigen binding fragment In some embodiments, the recombinant receptor is a chimeric antigen receptor (RAQ).
[0041] [0041] In particular embodiments of any of the articles of manufacture provided, the recombinant receptor includes an extracellular domain containing an antigen-binding domain. In some embodiments, the antigen-binding domain is or includes an antibody or antibody fragment thereof, which optionally is a single chain fragment. In some embodiments, the fragment includes variable regions of antibody joined by a flexible ligand. In some embodiments, the fragment includes an scFv.
[0042] [0042] In some embodiments of any of the articles of manufacture or methods provided, the recombinant receptor also includes a spacer and / or an articulation region.
[0043] [0043] In certain embodiments, any of the articles of manufacture or methods provided, the recombinant receptor includes an intracellular signaling region. In some embodiments, the intracellular signaling region includes an intracellular signaling domain. In some embodiments of any of the articles of manufacture supplied, the intracellular signaling domain is or includes a primary signaling domain, a signaling domain that is capable of inducing a primary activation signal in a T cell, a signaling domain of a T cell receptor (TCR) and / or a signaling domain containing an immunoreceptor tyrosine-based activation motif (ITAM). In some embodiments, the intracellular signaling domain is or includes an intracellular signaling domain of a CD3 chain, optionally a CD3-zeta (CD36) chain or a signaling portion thereof.
[0044] [0044] In particular embodiments of any of the articles of manufacture or methods provided, the recombinant receptor also includes a transmembrane domain disposed between the extracellular domain and the intracellular signaling region.
[0045] [0045] In some embodiments of any of the articles of manufacture or methods provided, the intracellular signaling region also includes a co-stimulating signaling region. In some embodiments, the co-stimulatory signaling region includes an intracellular signaling domain of a T-cell co-stimulating molecule or a signaling portion thereof. In some embodiments of any of the manufactured articles provided, the signaling - co-stimulating region includes an intracellular signaling domain of a CD28, a 4-1BB or an ICOS or a signaling portion thereof. In some embodiments, the co-stimulating signaling region is between the transmembrane domain and the intracellular signaling region.
[0046] [0046] In some modalities, the methods and articles are for or are capable of treating an individual with non-Hodgkin's lymphoma (NHL). In some respects, the method involves and / or the article of manufacture specifies or includes formulations capable of administering to the individual a dose or plurality of T cells. In some respects,
[0047] [0047] In some embodiments, the dose of T cells comprises between or about 5 x 107 T cells of RAQ expression and 1 x 10th T cells of RAQ expression, inclusive; and NHL comprises diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP), NOS (new or transformed from indolent lymphoma) or Grade 3B follicular lymphoma and in which the individual is or has been identified as having an Eastern Cooperative Oncology Group Performance Status (ECOG) status of O or 1.
[0048] [0048] In some modalities of any of the provided modalities, the methods further comprise identification or the article of manufacture includes information that specifies the treatment of an individual with diffuse large B cell lymphoma (LDGCB), primary large mediastinal B cell lymphoma (LCBMP), NOS (again or transformed from indolent lymphoma) or Grade 3B follicular lymphoma with an ECOG status of 0 or 1. In some modalities of any of the modalities provided, the dose of T cells and / or the administered cells comprises a defined ratio of CD4 * cells expressing RAQ to CD8 * cells expressing RAQ and / or CD4 * cells to CD8 * cells, the ratio of which is optionally approximately 1: 1 or between or approximately 1: 3 and approximately 3: 1 .
[0049] [0049] In some respects, the modalities are for the treatment of an individual having non-Hodgkin's lymphoma (NHL) and involve administering to the individual a dose of T cells comprising T cells that express a chimeric antigen (RAQ) receptor that specifically binds to a target antigen expressed by NHL.
[0050] [0050] In particular modalities of any of the modalities provided, the individual is or has been identified as or is specified as having an Eastern Cooperative Oncology Group Performance Status (ECOG) of O, 1 or 2. In certain modalities of any of the modalities provided , the individual is either identified or specified as having an ECOG status of O or 1.
[0051] [0051] In some modalities of any of the modalities provided, the methods and / or uses and / or administration of cells according to the articles of manufacture, achieve certain results and / or are associated with certain reduced toxicity risks, for example, in the population of individuals treated according to the methods or according to the information provided in the article of manufacture. In some aspects, at least 35%, at least 40% or at least 50% of the individuals treated according to the method achieved a complete response (CR) and / or a durable CR; and / or at least 50%, at least 60% or at least 70% of the individuals treated according to the method achieve the objective response (RO) and / or a durable RO. In particular modalities of any of the methods provided, the answer is durable for more than 3 months or more than 6 months. In some modalities, at least 40%, at least 50%, at least 60%, at least 70% of the individuals who, on or before the administration of the cell dose, had or were identified as having a doublef / triple hit lymphoma or relapse, optionally relapse within 12 months, after administration of an autologous stem cell transplant (TACT), reached an RO, optionally, in which the RO is durable for or more than 3 months or at least 6 months. In certain modalities of any of the methods provided, greater than or equal to about 50% of the individuals treated according to the method do not exhibit a grade 3 or higher cytokine release syndrome (SLC) or a grade 3 or higher neurotoxicity. In some modalities, these individuals do not exhibit early-onset SLC and / or neurotoxicity.
[0052] [0052] Here are provided methods to assess the likelihood of a response to a cell therapy, methods involving: assessing the level, quantity or concentration of one or more analyzed in a biological sample, in which the one or more analyzed (s) is selected from ferritin, LDH, CXCL10, G-CSF and IL-10, where: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the subject before administering the cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and individually compare the level, quantity or concentration of the analyzed in the sample to a threshold level, thus determining the probability that an individual will achieve a response to cell therapy. In some embodiments, the methods also involve administering cell therapy to the individual, if the individual is likely to get a response.
[0053] [0053] Here are provided methods for selecting an individual for treatment, methods involving: assessing the level, quantity or concentration of one or more analyzed in a biological sample, in which the one or more analyzed (s) is selected from ferritin, LDH, CXCL10, G-CSF and IL-10, wherein: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor ; and the biological sample is obtained from the subject before administering the cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and selecting an individual likely to respond to treatment based on the results of determining the likelihood that an individual will respond to cell therapy by individually comparing the level, amount or concentration of the analyzed in the sample to a threshold level. In some embodiments, the methods also involve administering cell therapy to the individual selected for treatment.
[0054] [0054] Treatment methods are provided here, methods involving: selecting an individual who is likely to respond to treatment with cell therapy based on the results of determining the likelihood that an individual will respond to cell therapy by individually comparing the level, quantity or concentration of one or more analyzed in a biological sample, where the one or more analyzed (s) is selected from ferritin, LDH, CXCL10, G-CSF and IL-10, at a threshold level, where: the sample biological is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the subject before administering the cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and administering cell therapy to an individual selected for treatment.
[0055] [0055] In some embodiments, the individual is likely to get an answer if the level, quantity or concentration of one or more analyzed is below a threshold level and the individual is unlikely to get an answer if the level, quantity or concentration of one or more most analyzed is above a threshold level.
[0056] [0056] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and / or within a standard deviation below the median or average level , quantity or concentration, or is or is about the median or average level, quantity or concentration, of the one analyzed in a biological sample obtained from a group of individuals before receiving a cell therapy, in which each of the individuals of the group started to obtaining a response after administration of a therapeutic cell composition of recombinant receptor expression for the treatment of the same disease or condition.
[0057] [0057] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and it is within a standard deviation above the median or average level, quantity or concentration of the analyzed in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual in the group started to show stable disease (ED) and / or progressive disease (PD) after administration of a therapeutic cell composition of recombinant receptor expression for the treatment of the same disease or condition.
[0058] [0058] In some modalities, the answer comprises an objective answer. In some modalities, the objective response comprises a complete response (CR) or a partial response (PR).
[0059] [0059] Methods are provided here to assess the likelihood of a durable response to cell therapy, methods involving: assessing the level, quantity or concentration of one or more analyzed in a biological sample, where the one or more analyzed (s) ) is selected from LDH, ferritin, CRP, D-dimer, SAA-1, IL-6, II-10, IL-15, IL-16, TNF-a0, IFN-y, MIP-10, CXCL-10 , IL-8, MCP-1 and MIP-16, wherein: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the subject before administering the cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and individually compare the level, quantity or concentration of the analyzed in the sample to a threshold level, thus determining the probability that an individual will obtain a durable response to cell therapy.
[0060] [0060] In some embodiments, the methods also involve administering cell therapy to the individual if the individual is likely to get a response.
[0061] [0061] Here are provided methods for selecting an individual for treatment, methods involving: assessing the level, quantity or concentration of one or more analyzed in a biological sample, in which the one or more analyzed (s) is selected from among LDH , ferritin, CRP, D-dimer, SAA-1, IL-6, IL-10, IL-15, IL-16, TNF-a, IFN-y, MIP-1a, CXCL-10, IL-8, MCP- 1 and MIP-18, wherein: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor;
[0062] [0062] Treatment methods are provided here, methods involving: selecting an individual who is likely to respond to treatment with cell therapy based on the results of determining the likelihood that an individual will achieve a durable response to cell therapy by individually comparing the level , quantity or concentration of one or more analyzed in a biological sample up to a threshold level, in which the one or more analyzed (s) is selected from LDH, ferritin, CRP, D-dimer, SAA-1, IL-6, IL- 10, IL-15, IL-16, TNF-a, IFN-y, MIP-10a, CXCL-10, IL-8, MCP-1 and MIP-18, where: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the subject before administering the cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and administering cell therapy to an individual selected for treatment.
[0063] [0063] In some modalities, the individual is likely to obtain a durable response if the level, quantity or concentration of one or more analyzed is below a threshold level and the individual is not likely to obtain a durable response if the level, quantity or concentration of the one or more analyzed is above a threshold level.
[0064] [0064] In the modalities, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and / or within a standard deviation below the median or average level, quantity or concentration, or is or is about the median or average level, quantity or concentration, of the one analyzed in a biological sample obtained from a group of individuals before receiving a cell therapy, in which each individual of the group started to obtain a lasting response after administration of a therapeutic cell composition of recombinant receptor expression for the treatment of the same disease or condition.
[0065] [0065] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 11% or within 5% and he is within a standard deviation above the median or average level, quantity or concentration of the analyzed in a biological sample obtained from a group of individuals before receiving cell therapy, in which each of the individuals in the group did not obtain a durable response after administration of a therapeutic cell composition of recombinant receptor expression for treatment of the same disease or condition.
[0066] [0066] In some modalities, the durable response comprises a complete response (RC) or partial response (RP) that is durable for at least 3 months, 4 months, 5 months or 6 months.
[0067] [0067] In some modalities, the durable response comprises an RC or PR that is durable for at least 3 months.
[0068] [0068] Methods are provided here to assess the risk of developing toxicity after administering cell therapy, methods involving assessing the level, quantity or concentration of one or more analyzed in a biological sample from an individual or a volumetric measure of tumor burden in an individual, in which the one or more analyzed (s) is selected from LDH, Ferritin, C-reactive protein (CRP), D-dimer (fibrin degradation product), IL-6, IL-8, IL- 10, IL-15, IL-16, TNF-a, IFN-02, MCP-1, MIP-1a and MIP-1B, wherein: the individual is a candidate for treatment with cell therapy, said cell therapy optionally comprising a dose or composition of genetically engineered cells expressing a recombinant receptor; and the biological sample is obtained from the subject before administering the cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and to compare, individually, the level, quantity or concentration of the analyzed in the sample or the volumetric measurement of the tumor load with a threshold level, thus determining the risk of developing toxicity after the administration of cell therapy.
[0069] [0069] Here are provided methods to identify an individual, methods involving assessing the level, quantity or concentration of one or more analyzed in a biological sample from an individual or a volumetric measurement of the tumor burden on an individual, where the one or more most analyzed (s) is selected from LDH, Ferritin, C-reactive protein (PCR), D-dimer (fibrin degradation product), IL-6, IL-8, IL-10, I1L-15, IL-16 , TNF-a, IFN-02, MCP-1, MIP-10 and MIP-168, wherein: the individual is a candidate for treatment with cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the subject before administering the cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and identifying an individual who is at risk of developing toxicity after administering cell therapy based on individually comparing the level, quantity or concentration of the analyzed in the sample or the tumor volume volumetric measurement at a threshold level.
[0070] [0070] Treatment methods are provided here, comprising assessing the level, quantity or concentration of one or more analyzed in a biological sample from an individual or a volumetric measurement of the tumor burden on the individual, in which the one or more analyzed (s) is selected from LDH, Ferritin, C-reactive protein (PCR), D-dimer (fibrin degradation product), IL-6, IL-8, IL-10, IL-15, IL-16, TNF-a, IFN- a2, MCP-1, MIP-10a and MIP-18, wherein: the subject is a candidate for treatment with cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the subject before administering the cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and to compare, individually, the level, quantity or concentration of the analyzed in the sample or the volumetric measurement of the tumor load with a threshold level, thus determining the risk of developing a toxicity after the administration of cell therapy; and after or based on the results of the assessment, administer to the individual cell therapy and, optionally, an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity.
[0071] [0071] In some embodiments, the biological sample is a blood or plasma sample.
[0072] [0072] In some modalities, the tumor volume volumetric measurement is a sum of the product dimensions (SDP) or is a volumetric measurement based on the CT and / or MRI image or another body image. In some modalities, the volumetric measurement of the tumor load is performed before treatment, before apheresis or before the manufacture of the cellular product.
[0073] [0073] In some modalities, the methods also involve monitoring the individual for symptoms of toxicity, if the individual is administered with cell therapy and is identified as having a risk of developing toxicity.
[0074] [0074] In some modalities, the individual has a risk of developing toxicity if the level, quantity or concentration of one or more of the analyzers or the volume measurement of the tumor load is above a threshold level and the individual has a low risk of develop toxicity if the level, quantity or concentration of one or more of those analyzed or the volume measurement of the tumor load is below a threshold level.
[0075] [0075] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and he is within a standard deviation above the median or average level, quantity or concentration, or is or is about the median or average level, quantity or concentration, of the analyzed tumor volume volumetric measurement in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual of the group continued to develop no toxicity after receiving a therapeutic cell composition of recombinant receptor expression for the treatment of the same disease or condition.
[0076] [0076] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and / or within a standard deviation below the median or average level , amount or concentration of the analyte or the volumetric measurement of tumor load in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual in the group continued to develop toxicity after receiving a therapeutic cell composition from expression of the recombinant receptor for the treatment of the same disease or condition.
[0077] [0077] In some embodiments, the toxicity is neurotoxicity or SLC.
[0078] [0078] In some embodiments, the toxicity is neurotoxicity or SLC grade 1 or higher.
[0079] [0079] In some embodiments, the toxicity is severe neurotoxicity or is neurotoxicity of grade 2 or higher, a neurotoxicity of grade 3 or higher, at least prolonged grade 3 neurotoxicity or is equal to or greater than grade 4 or 5 neurotoxicity; or the toxicity is severe SLC or comprises grade 2 or higher or grade 3 or higher.
[0080] [0080] In some modalities, the toxicity is neurotoxicity and the volume measurement of the tumor load is SDP and the one or more analyzed is selected from LDH, IL-10, IL-15, IL-16, TNF-a and MIP-16B.
[0081] [0081] In some modalities, the toxicity is neurotoxicity and one or more analyzed are evaluated and the analyzed are selected from LDH, Ferritin, CRP, IL-6, IL-8, 11-10, TNF-a, IFN-a2, MCP-1 and MIP-1B.
[0082] [0082] In some modalities, toxicity is neurotoxicity and one or more analyzed are evaluated and the analyzed are selected from IL-8, I1L-10 and CXCL10.
[0083] [0083] In some embodiments, neurotoxicity is severe neurotoxicity or neurotoxicity of grade 3 or higher.
[0084] [0084] In some embodiments, the toxicity is SLC and the one or more analyzed or tumor volume volumetric measurement is selected from LDH, SPD, PCR, d-dimer, IL-6, IL-15, TNF-a and MIP-1a .
[0085] [0085] In some modalities, the SLC is a serious SLC or an SLC of grade 3 or higher.
[0086] [0086] In some modalities, if the individual is identified as having a risk of developing toxicity, administer to the individual: (1) an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating development or development risk toxicity and (2) cell therapy, in which administration of the agent must be administered (i) before, (ii) within one, two or three days, (ili) simultaneously with and / or (iv) in the first fever after starting the administration of cell therapy to the individual; and / or cell therapy at a reduced dose or at a dose that is not associated with the risk of developing serious toxicity or toxicity or that is not associated with the risk of developing serious toxicity or toxicity in most individuals and / or most individuals having a disease or condition in which the individual has, or is suspected of having, after administration of cell therapy; and / or administer to the individual cell therapy in a hospital setting and / or with admission to the hospital for one or more days, optionally in which cell therapy should otherwise be administered to patients on an outpatient basis or without admission to the hospital for one or more days .
[0087] [0087] In some embodiments, the agent or other treatment is an anti-IL-6 antibody or an anti-IL6 receptor antibody.
[0088] [0088] In some embodiments, the agent or other treatment is or comprises an agent selected from tocilizumab, siltuximab, clazakizumab, sarilumab, olokizumab (CDP6038), elsiimomabe, ALD518 / BMS-945429, sirukumabe (CNTO 136), CPSI- 2634, ARGX-109, FE301 and FM101.
[0089] [0089] In some embodiments, the agent or other treatment is or comprises a steroid, optionally dexamethasone.
[0090] [0090] In some modalities, a volumetric measure is evaluated and the volumetric measure is SDP and the threshold level is or is it about 30 cm , is it or is it about 40 cm , is it or is it about 40 cm , is it or is it about 50cm , is it or is it about 50cm , is it or is it about 60cm or is it or is it about 70cm . In some embodiments, the volumetric measure is SDP and the threshold level is or is approximately 50 cm .
[0091] [0091] In some modalities, the one or more analyzed (s) is or comprises LDH and the threshold level is or is about 300 units per liter, is or is about 400 units per liter, is or is about 500 units per liter or is or is about 600 units per liter. In some modalities, the analyzed is LDH and the threshold level is or is around 500 units per liter.
[0092] [0092] In some embodiments, the recombinant receptor specifically binds to an antigen associated with the disease or condition or expressed in the cells of the environment of an injury associated with the disease or condition. In some embodiments, the disease or condition is cancer. In some modalities, the disease or condition is a myeloma, leukemia or lymphoma. In some embodiments, the disease or condition is a B-cell malignancy and / or is acute lymphoblastic leukemia (ALL), adult ALL, chronic lymphoblastic leukemia (LLC), non-Hodgkin's lymphoma (NHL) and diffuse large B-cell lymphoma ( LDGCB).
[0093] [0093] In some embodiments, the recombinant receptor is a chimeric antigen (RAQ) receptor. In some embodiments, the modified cells comprise T cells, optionally CD4 * and / or CD8 *. In some embodiments, T cells are primary T cells obtained from an individual or are autologous to the individual.
[0094] [0094] Here are provided methods of treating an individual having non-Hodgkin's lymphoma (NHL) methods comprising administering to the individual a dose of T cells comprising T cells that express a chimeric antigen (RAQ) receptor that specifically binds to a target antigen expressed by the NHL, wherein: the dose of T cells comprises between about 5 x 107 T cells of recombinant receptor expression and 1 x 108 T cells of recombinant receptor expression, including said dose comprising a defined ratio from CD4 * cells that express the recombinant receptor to CD8 * cells that express the recombinant receptor and / or from CD4 * cells to CD8 * cells, whose ratio is approximately or is 1: 1; and the method results in (1) a complete response (CR) in at least 35%, at least 40% or at least 50% of the treated individuals and / or objective response (RO) in at least 50%, at least 60% or at least 70% of treated individuals and (2) results in no more than 50% of individuals exhibiting a cytokine release syndrome (SLC) greater than grade 2 and / or neurotoxicity greater than grade 2.
[0095] [0095] In some embodiments of any of the methods provided, at least 40%, at least 50%, at least 60%, at least 70% of the individuals who, at or before administration of the cell dose had or were identified as having a double / triple hit lymphoma (or high grade B cell lymphoma, with MYC and BCL2 rearrangements and / or BCL6 with LDGCB histology (double / triple hit)) or relapse after administration of an autologous stem cell transplant (TACT ), obtained an RO, optionally, in which the RO is durable for either more than 3 months or for another 6 months.
[0096] [0096] In some modalities of any of the methods provided, the RC or RO is durable for more than 3 months or more than 6 months. In particular modalities of any of the methods provided, more than or more than about 50% of the individuals treated according to the method do not exhibit any degree of cytokine release syndrome (SLC) or neurotoxicity.
[0097] [0097] In some modalities, the RC or RO is durable for more than 3 months or more than 6 months; at least 20%, at least%, at least 35%, at least 40% or at least 50% of the individuals treated according to the method achieve an CR that is durable; at least 60%, 70%, 80%, 90% or 95% of individuals treated with the method and who achieve CR, remain in CR or remain in response or remain surviving for at least 3 months or for at least 6 months or in or more 9 months; and / or in which at least 60%, 70%, 80%, 90% or 95% of individuals treated with the method who achieve CR for one month and / or for three months remain in response, remain in CR and / or survive or survive without progression, for more than 3 months and / or for more than 6 months and / or for more than nine months; and / or at least 50%, at least 60% or at least 70% of the individuals treated according to the method reach the objective response (RO) optionally, in which the RO is durable or is at least 60% durable, 70 %, 80%, 90% or 95% of the individuals who reached the RO, for at least 3 months or at least 6 months; and / or in which at least 60%, 70%, 80%, 90% or 95% of individuals treated with the method and who achieve an RO remain in response or survive for at least 3 months and / or at least 6 months .
[0098] [0098] In some modalities, on or before the administration of the cell dose, the individual is or has been identified as having an associated lymphoma or involving the central nervous system (CNS); and / or at least 70%, at least 80%, at least 90% or at least 95% of the subjects treated according to the method that, at the time of administration or before the dose of cells displayed or were identified as exhibiting a lymphoma with CNS involvement, reached a resolution of CNS disease.
[0099] [0099] Here are provided methods of treating an individual, the method involving administration to an individual who has lymphoma, a dose of T cells comprising T cells that express a chimeric antigen receptor (RAQ) that specifically binds to a target antigen expressed by lymphoma, in which the individual's lymphoma is associated with or involves the involvement of the central nervous system (CNS). In some respects, at the time or before the dose of the cells is administered, the individual comprises a brain injury, optionally a brain injury to the temporal lobe. In some instances, the lymphoma is a B-cell malignancy. In some embodiments, the lymphoma is a non-Hodgkin's lymphoma (NHL).
[00100] [00100] In some of these modalities, at least 35%, at least 40% or at least 50% of the individuals treated according to the method achieved a complete response (CR) or remission of the CNS disease and / or achieved reduction or clearance CNS disease, optionally in which CR or remission or reduction or clearance of CNS disease is durable or is durable in at least 60%, 70%, 80%, 90% or 95% of individuals who achieve CR, for example at least 3 months or for at least 6 months; and / or at least 60%, 70%, 80%, 90% or 95% of individuals who achieve CR or remission or other reduction of CNS disease in one month and / or in three months remain in response, remain in remission , for example, in CR, or remain showing signs of reduction or remission and / or survive or survive without progression, for at least 3 months or more and / or for at least 6 months and / or for at least 9 months; and / or at least 50%, at least 60% or at least 70% of the individuals treated according to the method achieve the objective response (RO) or remission of the CNS disease optionally, in which the RO or remission of the CNS disease it is durable, or it is durable in at least 60%, 70%, 80%, 90% or 95% of individuals who achieve CR, for at least 3 months or for at least 6 months; and / or at least 60%, 70%, 80%, 90% or 95% of individuals who achieve OR or CNS disease remission remain in response or survive for at least 3 months or at least 6 months; and / or the brain injury is reduced in size or volume, optionally by more than or more than about 25%, 50%, 75% or more. In some respects, reduction or remission or clearance of CNS disease is achieved without or without substantial signs or symptoms of toxicity, such as neurotoxicity such as severe neurotoxicity, for example, neurotoxicity greater than grade 2 or greater than grade 3 and / or without toxicity caused by the activation or presence of cell therapy cells in the individual's brain and / or is achieved without an increased level of toxicity, compared to an individual in which CNS disease remains and / or is treated with therapy, however, that does not exhibit CNS disease.
[00101] [00101] In some modalities of any of the methods provided, greater than or equal to about 30%, 35%, 40% or 50% of the individuals treated according to the method do not exhibit any degree of cytokine release syndrome (SLC) or neurotoxicity. In some modalities of any of the methods provided, at least about 45%, 50%, 60%, 65%, 70%, 75%, 80%, 85%, 90% or 95% of the individuals treated according to the method do not show early-onset SLC or neurotoxicity and / or do not show SLC before 3 days after the start of administration and / or do not show onset of neurotoxicity before 5 days after start of administration and / or where the median onset of neurotoxicity between subjects treated according to the method is equal to or after the mean peak of, or mean time to resolution of the SLC in the subjects treated according to the method and / or the median onset of neurotoxicity among the subjects treated according to the method is greater than or about 8, 9, 10 or 11 days.
[00102] [00102] In certain embodiments of any of the methods provided, prior to commencing cell dose administration, the individual was not administered with an agent or treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing toxicity. In certain modalities of any of the methods provided, the individual is not administered an agent or treatment for the treatment or prevention or reduction or mitigation of neurotoxicity and / or a cytokine release syndrome or risk thereof, within a period of time after dose administration, the time period of which is optionally on or about 1, 2, 3, 4, 5 days or is optionally on or about 6, 7, 8, 9, 10, 11 days or is optionally 1, 2 , 3 or 4 weeks. In certain modalities of any of the methods provided, the individual is not administered with an agent or treatment for the treatment or prevention or reduction or mitigation of neurotoxicity and / or a cytokine release syndrome or risk of it, after administration of the dose , before or unless the individual displays a sign or symptom of toxicity and / or before or unless the individual displays a sign or symptom of toxicity other than a fever, optionally where the fever is not a prolonged fever or fever is or has been reduced or reduced by more than 1 ° C after treatment with an antipyretic. In certain modalities of any of the methods provided, administration and any follow-up are performed on an outpatient basis and / or without admitting the individual to a hospital and / or without an overnight stay in a hospital and / or without the need for admission or overnight stay in a hospital, optionally , unless or until the individual has a prolonged fever or the fever has been reduced or not reduced by more than 1 ºC after treatment with antipyretic.
[00103] [00103] In some embodiments of any of the methods provided, prior to commencing cell dose administration, the subject was not administered an anti-IL-6 or anti-IL-6R antibody, optionally tocilizumab or situximab, and / or was not administered with a steroid, optionally dexamethasone. In certain modalities of any of the methods provided, the individual is not administered an anti-IL-6 or anti-IL-6R antibody, optionally tocilizumab or siltuximab, and / or has not been administered with a steroid, optionally dexamethasone, within a time period after dose administration, the time period of which is optionally either about 1, 2, 3, 4, 5 days or is optionally either about 6, 7, 8, 9, 10, 11 days or is optionally 1, 2, 3 or 4 weeks. In certain modalities of any of the methods provided, the individual is not administered an anti-IL-6 or anti-IL-6R antibody, optionally tocilizumab or siltuximab, and / or has not been administered with a steroid, optionally dexamethasone, after administration cell dose, before or unless, the individual exhibits a sign or symptom of a toxicity, optionally a neurotoxicity or SLC and / or before, or unless the individual exhibits a sign or symptom of a toxicity, optionally a neurotoxicity or SLC, other than fever, optionally where the fever is not a prolonged fever or the fever is or has been reduced by more than 1 ° C after treatment with antipyretic. In certain modalities of any of the methods provided, administration and any follow-up are performed on an outpatient basis and / or without admitting the individual to a hospital and / or without an overnight stay in a hospital and / or without the need for admission to or overnight in a hospital, optionally, unless or until the individual has a prolonged fever or that has been reduced or not reduced by more than 1 ºC after treatment with antipyretic.
[00104] [00104] In some modalities of any of the methods provided, administration is performed on an outpatient basis and / or without the need for admission or overnight in a hospital. In some modalities of any of the methods provided, if the individual, who is or has been treated on an outpatient basis, exhibits prolonged fever or fever which is or has not been reduced or not reduced by more than 1 ° C after treatment with an antipyretic, the individual is admitted in the hospital or overnight in a hospital and / or an agent or treatment is administered to treat or prevent or reduce or mitigate neurotoxicity and / or a cytokine release syndrome or risk thereof.
[00105] [00105] In particular modalities of any of the methods provided, NHL is selected from the group consisting of aggressive NHL, diffuse large B cell lymphoma (LDGCB), NOS (again and transformed from indolent), mediastinal large B cell lymphoma primary (LCBMP), lining cell lymphoma (CSF) and / or follicular lymphoma (LF), optionally Grade 3B follicular lymphoma (LF3B). In certain modalities of any of the methods provided, the NHL comprises diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP), NOS (again or transformed from indolent lymphoma) or Grade 3B follicular lymphoma. In some examples, the NHL includes LDGCB. In some modalities of any of the methods provided, the LDGCB is again or transformed from follicular lymphoma (LF) and / or does not comprise LDGCB transformed from LZM and LLC (Richter).
[00106] [00106] In particular modalities of any of the methods provided, the individual is or has been identified as having an Eastern Cooperative Oncology Group Performance Status (ECOG) of 0, 1 or 2. In certain modalities of any of the methods provided, the individual is or was identified as having an ECOG status of O or 1. In some embodiments of any of the methods provided, at or just before the dose of cells was administered, the individual relapsed following remission after treatment with, or became refractory to one or more previous therapies for NHL, optionally one, two or three previous therapies other than another dose of cells that express RAOQ.
[00107] [00107] In some modalities of any of the methods provided, on administration or before the cell dose, the individual is or has been identified as having an associated lymphoma or involving the involvement of the central nervous system (CNS). In some modalities of any of the methods provided, at least 70%, at least 80%, at least 90% or at least 95% of the subjects treated according to the method that, at the time of administration or before the dose of cells exhibited or were identified to exhibit a lymphoma with CNS involvement, achieved resolution of the CNS disease.
[00108] [00108] In particular modalities of any of the methods provided, on or before cell dose administration: the individual is or has been identified as having a doublerftriple hit lymphoma (or high grade B cell lymphoma, with MYC and BCL2 rearrangements and / or BCL6 with LDGCB histology (double / triple hit)); the individual is or has been identified as having a chemo-refractory lymphoma, optionally a chemo-refractory LDGCB; the individual did not achieve complete remission (CR) in response to previous therapy; and / or the individual relapsed within 1 year or less than 1 year after receiving an autologous stem cell transplant (TACT).
[00109] [00109] In some embodiments of any of the methods provided, the method includes, prior to administration of the cell dose, identifying or selecting an individual for the administration of the cell dose who has a hit doublertriple lymphoma (or high B cell lymphoma) grade, with MYC and BCL2 rearrangements and / or BCL6 with histology of LDGCB (double / triple hit)), a chemo-refractory lymphoma, optionally a chemo-refractory LDGCB, has not achieved complete remission (CR) in response to previous therapy to treat malignancy, optionally the LNH; and / or relapsed within 1 year or less than 1 year after receiving an autologous stem cell transplant (TACT); and / or has a lymphoma associated with or involving the involvement of the central nervous system (CNS).
[00110] [00110] In some embodiments of any of the methods provided, the method further includes administration of a therapeutic agent or additional therapy, optionally different from cell therapy, optionally different from RAQ T cell therapy *. In some embodiments, the therapeutic agent or additional therapy is for the treatment of NHL or malignancy and / or increases the persistence, activity and / or effectiveness of the cell dose. In some embodiments, the therapeutic agent or additional therapy is administered if the individual does not exhibit a response, optionally does not exhibit a CR or RO, to cell therapy within 1 month, within 2 months or within 3 months after dose administration. of cells. In some embodiments, the therapeutic agent or additional therapy is administered to an individual: who is or has been identified as having stable or progressive disease (ED / PD) after treatment with a previous therapy, optionally a previous therapy with a chemotherapeutic agent, which is or has been identified with an Eastern state
[00111] [00111] In certain modalities of any of the methods provided, the RAQ comprises an antigen-specific scFv, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulating molecule, which optionally is a 41BB and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which optionally is a CD3zeta. In some embodiments of any of the methods provided, the antigen is a B cell antigen, which is optionally CD19.
[00112] [00112] In particular modalities of any of the methods provided, prior to administration, the individual was preconditioned with a lymphodeplective therapy comprising the administration of fludarabine and / or cyclophosphamide. Certain modalities of any of the methods provided further comprise, immediately prior to administration, the administration of a lymphodeplective therapy to the individual, comprising the administration of fludarabine and / or cyclophosphamide. In some embodiments of any of the methods provided, the lymphodeplector comprises the administration of cyclophosphamide at about 200-400 mg / m , optionally at or about 300 mg / m , including and / or fludarabine at about 20-40 mg / m , optionally 30 mg / m , daily for 2-4 days, optionally for 3 days. In particular embodiments of any of the methods provided, does lymphodeplet therapy comprise the administration of cyclophosphamide at about 300 mg / m and fludarabine at about 30 mg / m daily for 3 days.
[00113] [00113] In certain modalities of any of the methods provided, the administration of the cell dose and / or therapy for lymph nodes is performed via ambulatory release. In some embodiments of any of the methods provided, the cell dose is administered parenterally, optionally intravenously.
[00114] [00114] In particular modalities of any of the methods provided: at least 40% or at least 50% of the individuals treated according to the method achieve complete remission (CR), exhibit progression-free survival (SLP) and / or overall survival ( SG) greater than or about 3 months, 6 months or 12 months; on average, subjects treated according to the method exhibit a median SLP or SG greater than or about 6 months, 12 months or 18 months; and / or the individual exhibits SLP or SG after therapy for at least about 6, 12, 18 or more months. In certain embodiments of any of the methods provided, at or about 14 or 28 days after the start of cell dose administration, the number of RAQ * T cells, optionally RAQ * CD8 * cells and / or RAQ T cells * CD4 *, detectable in the individual's blood, or in most of the individuals so treated by the method, is greater than 1 cell per uL, greater than 5 cells per uL or greater than 10 cells per uL.
[00115] [00115] In some embodiments of any of the methods provided, T cells are primary T cells obtained from an individual. In particular embodiments of any of the methods provided, T cells are autologous to the individual. In certain modalities of any of the methods provided, T cells are allogeneic to the individual. In some embodiments of any of the methods provided, T cells comprise CD4 * and CD8 * T cells administered as a plurality of compositions, said plurality of compositions comprising administering a first composition comprising CD4 * T cells or T cells CD8 * and administration of a second composition comprising the other of CD4 * T cells or CD8 * T cells.
[00116] [00116] In particular modalities of any of the methods provided, the first composition and the second composition are administered O to 12 hours separately, O to 6 hours separately or O to 2 separately. In certain embodiments of any of the methods provided, the first composition and the second composition are administered no more than 2 hours, no more than 1 hour, no more than 30 minutes, no more than 15 minutes, no more than 10 minutes or not more than 5 minutes separately. In some embodiments of any of the methods provided, the first composition comprises the CD4 * T cell. In particular embodiments of any of the methods provided, the first composition comprises CD8 * T cells. In certain embodiments of any of the methods provided, the first composition is administered before the second composition.
[00117] [00117] In some embodiments of any of the methods provided, the dose of T cells is administered to the individual as a single dose or is administered only once within a period of two weeks, one month, three months, six months, | year or more. In particular embodiments of any of the methods provided, the dose of T cells is administered as a double dose, comprising a first dose of T cells and a consecutive dose of T cells, wherein one or both of the first dose and the second dose comprises ( m) administering the plurality of T cell compositions. In certain embodiments of any of the methods provided, the consecutive dose is administered at a point in time that is at least or more than about 7 days or 14 days after and less than about 28 days after starting the first dose of cells.
[00118] [00118] An article of manufacture is provided here which comprises a cell therapy comprising a dose or composition of genetically modified cells expressing a chimeric antigen receptor (RAQ) and instructions for administering the cell therapy, in which the instructions specify: cell dose is administered to an individual who has or has identified non-Hodgkin's lymphoma (NHL), the NHL selected from diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP), NOS (from new or transformed from indolent lymphoma) or Grade 3B follicular lymphoma, in which the individual is or has been identified as having an Estern Cooperative Oncology Group Performance Status (ECOG) status of O or 1; and the dose of T cells to be administered comprises between about 5 x 10 7 RAQ expression T cells and 1 x 10 ° RAQ expression T cells, inclusive. In some embodiments of any of the articles of manufacture provided, the instructions specify the administration of the dose of T cells into a defined ratio of CD4 * cells that express the RAQ to CD8 * cells that express the RAQ and / or CD4 * cells to cells CD8 *, whose ratio is approximately 1
[00119] [00119] An article of manufacture is provided here which comprises a cell therapy comprising a dose or composition of genetically modified cells expressing a chimeric antigen receptor (RAQ) and instructions for administering the cell therapy, in which the instructions specify: T cell dose should be administered to a defined ratio of CD4 * cells that express the RAQ to CD8 + cells that express the RAQ and / or from CD4 * cells to CD8 * cells, the ratio of which is approximately or is 1: 1; and the cell dose should be administered to an individual having or identified as having non-Hodgkin's lymphoma (LNH), the LNH selected from diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP) , NOS (again or transformed from indolent lymphoma) or Grade 3B follicular lymphoma.
[00120] [00120] An article of manufacture is provided here which comprises a cell therapy comprising a dose or composition of genetically modified cells expressing a chimeric antigen receptor (RAQ) and instructions for administering the cell therapy, in which the instructions specify: cell dose should be administered to an individual having or identified as having non-Hodgkin's lymphoma (NHL), optionally an NHL selected from aggressive NHL, diffuse large B cell lymphoma (LDGCB), NOS (again and turned into indolent ), primary mediastinal B-cell lymphoma (LCBMP), lining cell lymphoma (CSF) and / or follicular lymphoma (LF), optionally Grade 3B follicular lymphoma (LF3B), the dose of T cells to be administered comprises between or about 5 x 107 RAQ expression T cells and 1 x 10th RAQ expression T cells, inclusive; and the dose of T cells must be administered in a defined ratio of cells
[00121] [00121] In some embodiments of any of the manufactured articles provided, the instructions further specify that the cell dose should be administered to an individual who is or has been identified as having an Eastern Cooperative Oncology Group Performance Status (ECOG) of 0, 1 or 2, optionally, an ECOG status of 0 or 1. In certain embodiments of any of the manufactured articles provided, the instructions specify that the administration is to an individual who has not received, either immediately before the dose of cells or within or about 1 month of the cell dose, an agent or treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity. In some embodiments of any of the articles of manufacture provided, the agent is or comprises an anti-IL-6 or anti-IL-6R antibody, optionally tocilizumab or siltuximab, and / or a steroid, optionally dexamethasone. In particular embodiments of any of the articles of manufacture provided, the instructions specify that the cell dose is not for administration to an individual with LDGCB transformed from LZM and LLC (Richter's) and / or is to an individual with an LDGCB that is again or transformed from indolent disease. In some embodiments of any of the manufactured articles provided, the instructions specify that the individual does not have an LDGCB transformed from LZM and LLC (Richter).
[00122] [00122] In some embodiments of any of the manufactured articles provided, the instructions specify that the administration of cell therapy is for an individual who is or has been identified as having a hit doublertriple lymphoma (or high grade B cell lymphoma,
[00123] [00123] “Particular modalities of any of the articles of manufacture supplied further comprise instructions for use with, after or in connection with a lymph-depletion therapy, the lymph-depletion therapy - optionally - comprising fludarabine and / or cyclophosphamide. In certain embodiments of any of the articles of manufacture supplied, lymphodepletizer therapy comprises the administration of cyclophosphamide at about 200-400 mg / m , optionally at or about 300 mg / m , inclusive, and / or fludarabine at about 20-40 mg / m , optionally 30 mg / m , daily for 2-4 days, optionally for 3 days. In particular embodiments of any of the articles of manufacture supplied, does lymphodeplective therapy include the administration of cyclophosphamide at about 300 mg / m and fludarabine at about 30 mg / m daily for 3 days.
[00124] [00124] In some modalities of any of the manufactured articles provided, the instructions further specify that the administration of cell therapy must be or can be administered to the individual on an outpatient basis and / or without admission of the individual to the hospital overnight or by one or more consecutive days and / or is not admitted to the hospital for one or more days. In certain embodiments of any of the articles of manufacture provided, the instructions further specify that cell therapy is for parenteral administration, optionally intravenous administration. In particular embodiments of any of the articles of manufacture provided, cell therapy comprises primary T cells obtained from an individual. In some embodiments of any of the manufactured articles provided, T cells are autologous to the individual. In certain embodiments of any of the manufactured articles provided, T cells are allogeneic to the individual.
[00125] [00125] In particular embodiments of any of the articles of manufacture provided, the article of manufacture comprises a plurality of cell therapy compositions, the plurality of compositions comprising a first composition of genetically modified cells comprising CD4 * T cells or CD8 * T cells, wherein the instructions specify that the first composition is for use with a second composition comprising the other CD4 * T cell or CD8 * T cell, optionally where the cells of the first composition and cells of the same composition are from the same individual .
[00126] [00126] In some embodiments of any of the manufactured articles provided, the instructions specify that the first composition and the second composition should be administered to a defined ratio of CD4 * cells that express the recombinant receptor to CD8 * cells that express the recombinant receptor and / or from CD4 * cells to CD8 * cells, the ratio of which is optionally approximately 1: 1 or between approximately 1: 3 and approximately 3: 1. In certain embodiments of any of the articles of manufacture provided, the defined ratio is either is approximately 1: 1. In particular embodiments of any of the manufactured articles provided, the composition further comprises a cryoprotectant and / or the article further includes instructions for defrosting the composition prior to administration to the individual.
[00127] [00127] In some embodiments of any of the articles of manufacture supplied, the instructions specify the administration of the composition comprising CD4 * T cells and the composition comprising CD8 * T cells at 12 hours separately, O at 6 hours separately or O to 2 hours separately. In certain embodiments of any of the manufactured articles provided, the instructions specify the administration. of the composition comprising the CD4 * T cells and the composition comprising the CD8 * T cells not more than 2 hours, not more than 1 hour, not more than 30 minutes, not more than 15 minutes, not more than than 10 minutes or no more than 5 minutes. In particular embodiments of any of the articles of manufacture provided, the instructions specify the administration of the composition comprising the CD4 * T cells before administering the composition comprising the CD8 * cells. In some embodiments of any of the articles of manufacture provided, the instructions specify the administration of the composition comprising the CD8 * T cells before administering the composition comprising the CD4 * cells.
[00128] [00128] Manufacture articles are provided here comprising one or more reagents capable of detecting one or more analyzed and instructions for using the reagent to test a biological sample from an individual who is a candidate for treatment, optionally with cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells expressing a recombinant receptor, wherein the one or more analyzed (s) is selected from LDH, ferritin, CRP, IL-6, IL-7, IL- 8, I1L-10, IL-15, IL-16, TNF-alpha, IFN-gamma, MCP-1, MIP-1beta, eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, IP-10, perforin and D-dimer (fibrin degradation product).
[00129] [00129] “Particular modalities of any of the articles of manufacture supplied further comprise cell therapy and / or further comprise instructions for use with, before and / or in connection with treatment with cell therapy. Certain modalities of any of the articles of manufacture supplied further comprise one or more agents or treatments for the treatment, prevention, delay, reduction or mitigation of the development or risk of developing a toxicity and / or instructions for the administration of one or more agents or treatments to treat, prevent, delay, reduce or mitigate the development or risk of developing toxicity in the individual.
[00130] [00130] In some modalities of any of the manufactured articles provided, the instructions further specify whether the level, quantity or concentration of the analyzed in the sample is equal to or higher than a threshold level for the analyzed: administration to the individual of an agent or other treatment able to treat, prevent, delay, reduce or mitigate the development or risk of developing a toxicity (i) before, (ii) within one, two or three days, (iii) simultaneously with and / or (iv) in first fever after starting the administration of cell therapy to the individual; and / or administering cell therapy to the individual at a reduced dose or at a dose that is not associated with the risk of developing serious toxicity or toxicity, or is not associated with the risk of developing severe toxicity or toxicity in most individuals, and / or in most individuals having a disease or condition in which the individual has, or is suspected of having, after administration of cell therapy; and / or administering cell therapy to the individual in a hospital setting and / or with admission to the hospital for one or more days, optionally where cell therapy should be administered to individuals on an outpatient basis or without admission to the hospital for one or more days.
[00131] [00131] In particular modalities of any of the manufactured articles provided, the instructions further specify whether the level, quantity or concentration of the analyzed is below a threshold level for the analyzed, giving the individual cell therapy, optionally in a non-reduced dose , optionally on an outpatient basis or without admission to the hospital for one or more days.
[00132] [00132] In certain modalities of any of the manufactured articles provided, the instructions further specify the administration of cell therapy to the individual and in which the instructions further specify, whether the level, quantity or concentration of the analyzed is below a threshold level: the administration of cell therapy does not include the administration, before or concomitantly with the administration of cell therapy and / or before the development of a symptom sign of toxicity other than fever, an agent or treatment capable of treating, preventing, delaying or alleviating the development of toxicity; and / or the administration of cell therapy must be or can be administered to the individual on an outpatient basis and / or without admission of the individual to the hospital overnight or for one or more consecutive days and / or without admission of the individual to the hospital for one or more days .
[00133] [00133] In some modalities of any of the manufactured articles supplied, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% of the average level, quantity or concentration and / or is within a standard deviation of the average level, quantity or concentration, of that analyzed in a biological sample obtained from a group of individuals before receiving a therapeutic cellular composition of expression of the recombinant receptor, in which each individual in the group passed developing toxicity after receiving a therapeutic cell composition of recombinant receptor expression for the treatment of the same disease or condition. An article of manufacture is provided here comprising a cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells expressing a recombinant receptor and instructions for administering the cell therapy after or based on the results of an assessment, in a biological sample of the level, or quantity or concentration of one or more analyzed in a biological sample, said biological sample obtained from the individual prior to the administration of cell therapy and / or said biological sample not comprising the recombinant receptor and / or said modified cells, in which the one or more analyzed (s) is selected from LDH, ferritin, CRP, IL-6, IL-7, IL-8, II-10, IL-15, IL-16, TNF- alpha, IFN-gamma, MCP-1, MIP-1beta, eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, IP-10, perforin and D-dimer (fibrin degradation product).
[00134] [00134] In particular modalities of any of the manufactured articles provided, said evaluation comprises detection, which optionally comprises contacting a reagent capable of directly or indirectly detecting the one analyzed with the biological sample and determining the level, quantity or concentration of the one analyzed in the sample biological. Certain modalities of any of the articles of manufacture supplied further comprise the reagent and / or further comprise instructions for use with, before and / or in connection with the reagent to detect the analyzed. Some modalities of any of the articles of manufacture supplied further comprise one or more agents or treatments for treatment, prevention, delay, reduction or mitigation of the development or risk of developing a toxicity and / or instructions for the administration of one or more agents or treatments for treatment, prevention, delay, reduction or mitigation of development or risk of developing toxicity in the individual.
[00135] [00135] In particular modalities of any of the manufactured articles provided, the instructions for administering the cell therapy specify, if the level, quantity or concentration of the analyzed in the sample is equal to or higher than a limit: administer to the individual an agent or other treatment able to treat, prevent, delay, reduce or mitigate the development or risk of developing a toxicity (i) before, (ii) within one, two or three days, (iii) simultaneously with and / or (iv) in first fever after, the beginning of the administration of the therapeutic cell composition or of the genetically modified cells; and / or administering cell therapy to the individual at a reduced dose or at a dose that is not associated with the risk of developing serious toxicity or toxicity, or is not associated with the risk of developing severe toxicity or toxicity in most individuals, and / or in most individuals having a disease or condition in which the individual has, or is suspected of having, after administration of cell therapy; and / or administer to the individual cell therapy in a hospital setting and / or with admission to the hospital for one or more days, optionally in which the cell therapy is otherwise administered to patients on an outpatient basis or without admission to the hospital for one or more days .
[00136] [00136] In certain modalities of any of the articles of manufacture supplied, the instructions for administering the cell therapy specify, if the level, quantity or concentration of the analyzed in the sample is below a threshold level, administering to the individual the cell therapy, optionally in unreduced dose, optionally on an outpatient basis or without admission to the hospital for one or more days. In some modalities of any of the manufactured articles provided, the instructions further specify the administration of cell therapy to the individual and in which the instructions further specify, whether the level, quantity or concentration of the analyzed is below a threshold level: do not administer, before or simultaneously with the administration of cell therapy and / or before the development of a sign or symptom of a toxicity other than fever, an agent or treatment capable of treating, preventing, delaying or mitigating the development of toxicity; and / or the administration of cell therapy must be or can be administered to the individual on an outpatient basis and / or without admission of the individual to the hospital overnight or for one or more consecutive days and / or without admission of the individual to the hospital for one or more days .
[00137] [00137] In particular modalities of any of the manufactured articles supplied, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% of the average level, quantity or concentration and / or is within a standard deviation of the average level, quantity or concentration, of that analyzed in a biological sample obtained from a group of individuals before receiving a therapeutic cellular composition of expression of the recombinant receptor, in which each individual in the group passed developing toxicity after receiving a therapeutic cell composition of recombinant receptor expression for the treatment of the same disease or condition.
[00138] [00138] Manufacture articles are provided here comprising an agent capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity and instructions for administering the agent after or based on the results of an evaluation in a biological sample of the level, quantity or concentration of one or more analyzed in a biological sample, in which the one or more analyzed is selected from LDH, ferritin, CRP, IL-6, IL-7, IL-8, I1L -10, I1L-15, I1L-16, TNF-alpha, IFN-gamma, MCP-1, MIP-1beta, eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, | IP-10, perforin and D-dimer (fibrin degradation product). In certain modalities of any of the articles of manufacture supplied, said evaluation comprises detection, which optionally comprises contacting a reagent capable of directly or indirectly detecting the one analyzed with the biological sample and determining the level, quantity or concentration of the one analyzed in the biological sample.
[00139] [00139] In some embodiments of any of the manufactured articles provided, the instructions specify that the agent should be administered i) before, (ii) within one, two or three days, (iii) simultaneously with and / or (iv) in the first fever after the start of administration of cell therapy to the individual and / or further comprises instructions for use with, before and / or in connection with treatment with cell therapy. In particular embodiments of any of the articles of manufacture provided, said biological sample is obtained from the individual prior to administration of the agent or cell therapy. In certain embodiments of any of the articles of manufacture provided, the reagent is a binding molecule that specifically binds to the marker or cells of the myeloid cell population. In some embodiments of any of the articles of manufacture supplied, the reagent is an antibody or antigen-binding fragment thereof. In particular embodiments of any of the manufactured articles provided, the biological sample is or is obtained from a blood, plasma or serum sample. In certain embodiments of any of the articles of manufacture provided, comprising the reagent to detect the analyzed and / or further comprising instructions for use with, before and / or in connection with the reagent to detect the analyzed. Some embodiments of any of the articles of manufacture provided further comprise cell therapy and / or further comprise instructions for use with, before and / or in connection with treatment with cell therapy.
[00140] [00140] In particular modalities of any of the manufactured articles provided, the instructions for administering the agent specify, whether the level, quantity or concentration of the analyzed in the sample is equal to or above a threshold level, administering the agent to the individual. In certain embodiments of any of the articles of manufacture provided, the instructions further specify the administration of a cell therapy to the individual, in which the administration of the agent must be carried out (i) before, (ii) within one, two or three days , (ili) concomitantly with and / or (iv) in the first fever after the start of administration of cell therapy to the individual. In some embodiments of any of the articles of manufacture provided, the instructions for administering the agent specify, whether the level, quantity or concentration is below the threshold level that gives the individual cell therapy, optionally, where the instructions specify that cell therapy it should not be or can be administered to the individual on an outpatient basis and / or without the individual's admission to the hospital overnight or for one or more consecutive days and / or without the individual's admission to the hospital for one or more days.
[00141] [00141] In particular modalities of any of the manufactured articles provided, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% of the level,
[00142] [00142] In some embodiments of any of the manufactured articles provided, the toxicity comprises neurotoxicity or cytokine release syndrome (SLC), optionally grade 1 or higher neurotoxicity or SLC. In particular embodiments of any of the articles of manufacture supplied: the toxicity comprises severe neurotoxicity and / or comprises a neurotoxicity of grade 2 or greater, a neurotoxicity of grade 3 or greater, at least one prolonged grade 3 neurotoxicity or is equal to or greater than grade 4 or grade 5 neurotoxicity; and / or the toxicity comprises severe SLC and / or comprises SLC of grade 2 or higher or 3 or higher. In certain modalities of any of the manufactured articles provided, toxicity is associated with cerebral edema.
[00143] [00143] In some embodiments of any of the manufactured articles provided, the agent or other treatment is or comprises one or more of a steroid; a cytokine or cytokine receptor antagonist or inhibitor selected from IL-10, IL-10R, IL-6, IL-6 receptor, IFNy, IFNGR, IL-2, IL-2R / CD25, MCP-1, CCR2 , CCRA4, MIP1B, CCR5, TNFalpha, TNFRI1, IL-1 and IL-1IRalfa / IL-1beta; or an agent capable of preventing, blocking or reducing the activity or function of microglial cells. In particular embodiments of any of the articles of manufacture provided, the antagonist or inhibitor is or comprises an agent selected from an antibody or antigen binding fragment, a small molecule, a protein or peptide and a nucleic acid. In certain embodiments of any of the articles of manufacture provided, the agent or other treatment is an anti-IL-6 antibody or an anti-IL6 receptor antibody.
[00144] [00144] In some embodiments of any of the manufactured articles provided, the agent or other treatment is or comprises an agent selected from tocilizumab, siltuximab, clazakizumab, sarilumab, olokizumabe (CDP6038), elsilimomabe, ALD518 / BMS-945429, sirukumabe (CNTO 136), CPSI-2634, ARGX-109, FES301 and FM101. In particular embodiments of any of the articles of manufacture provided, the agent or other treatment is or comprises tocilizumab. In certain embodiments of any of the manufactured articles provided, the agent or other treatment is or comprises siltuximab. In some embodiments of any of the manufactured articles provided, the steroid is or comprises dexamethasone.
[00145] [00145] In particular modalities of any of the manufactured articles provided, the agent capable of preventing, blocking or reducing the activity or function of the microglial cells is selected from an anti-inflammatory agent, a NADPH oxidase (NOX2) inhibitor, a calcium channel blocker, a sodium channel blocker, inhibits GM-CSF, inhibits CSF1IR, specifically binds to CSF-1, specifically binds to IL-34, inhibits the activation of nuclear factor cover B (NF -KB), activates a CB receptor, and / or is a CB2 agonist, a phosphodiesterase inhibitor, inhibits microRNA-155 (miR-155) or over-regulates microRNA-124 (miR-124). In certain embodiments of any of the articles of manufacture supplied, the agent capable of preventing, blocking or reducing the activation or function of microglial cells is a small molecule, peptide, protein, antibody or antigen-binding fragment, a mimetic antibody, an aptamer , or a nucleic acid molecule.
[00146] [00146] In some modalities of any of the manufactured articles provided, the agent is selected from minocycline, naloxone, nimodipine, Riluzole, MOR103, lenalidomide, a cannabinoid (optionally WIN55 or 212-2), intravenous immunoglobulin (IVlg), ibudilaste, anti-miR-155 blocked nucleic acid (LNA), MCS110, PLX-3397, - “PLX647, PLX1I08-D1, PLX7486, JNJ-40346527, JNJ28312141, ARRY-382, AC-708, DCC-3014, 5- (3 -4) -methoxy-4 - ((4-methoxybenzyl) oxy) benzyl) pyrimidine-2,4-diamine (GW2580), AZD6495, Ki20227, BLZ945, emactuzumab, IMC-CS4, FPAOO8, LY-3022855, AMG-820 and TG-3003. In particular embodiments of any of the manufactured articles provided, the agent is an inhibitor of the colony stimulating factor 1 receptor (CSFIR). In certain modalities of any of the manufactured articles provided, the inhibitor is selected from: PLX-3397, PLX647, PLX108-D1, PLX7486, JNJ- 40346527, JNJ28312141, ARRY-382, AC-708, DCC-3014, 5- ( 3-methoxy-4 - ((4-methoxybenzyl) oxy) benzyl) pyrimidine-2,4-diamine (GW2580), AZD6495, Ki20227, BLZ945 or a pharmaceutical or prodrug salt thereof; emactuzumab, IMC-CS4, FPAO0O8, LY-3022855, AMG-820 and TG-3003 or is an antigen-binding fragment thereof; or a combination of any of the above. In some embodiments of any of the manufactured articles provided, the inhibitor is PLX-3397.
[00147] [00147] In certain modalities of any of the manufactured articles provided, the disease or condition is a cancer. In specific embodiments of any of the manufactured articles provided, the disease or condition is a myeloma, leukemia or lymphoma.
[00148] [00148] In certain modalities of any of the manufactured articles provided, the antigen is ROR1, B cell maturation antigen (BCMA), carbonic anhydrase 9 (CAIX), tEGFR, Her2 / neu (receptor tyrosine kinase erbB2), LI- CAM, CD19, CD20, CD 22, mesothelin, CEA and hepatitis B surface antigen, antifolate receptor, CD23, CD24, CD30, CD33, CD38, CD44, EGFR, epithelial glycoprotein 2 (GEP-2), epithelial glycoprotein 40 (EPG-40), EPHa2, erb-B2, erb-B3, erb-B4, erbB, EGFR vill, folate-binding protein (FBP), FCRL5, FOCRHS5, fetal acetylcholine receptor, GD2, GD3, HMW- MAA, 1L-22R-alpha, 1L-13R-alpha2, kinase insertion domain receptor (kdr), kappa light chain, Lewis Y, L1 cell adhesion molecule, (LI-CAM), melanoma-associated antigen ( MAGE) -A1, MAGE-A3, MAGE-AS6, preferably expressed melanoma antigen (AMEPE), survivin, TAG72, B7-H6, I1L-13 alpha-13 (IL-13Ra2), CA9, GD3, HMW- MAA, CD171, G250 / CAIX, HLA-AI MAGE Al, HLA-A2 NY-ESO-1, P SCA, folate receptor-a, CD44v6, CD44v7 / 8, integrin avb6, 8H9, NCAM, VEGF receptors, 574, fetal AchR, NKG2D, CD44v6 ligands, dual antigen, testicular cancer antigen, mesothelin, murine CMV, mucin 1 (MUC1), MUC16, PSCA, NKG2D, NY-ESO-1, MART-1, gp100, oncofetal antigen, ROR1, TAG72, VEGF-R2, carcinoembryonic antigen (CEA), Her2 / neu, estrogen receptor, receptor progesterone, ephrinB2, CD123, c-Met, GD-2, acetylated GD2 (GD20), CE7, Wilms tumor 1 (WT-1), an A2, CCL-1, CD138 cyclin, protein receptor coupled to G protein 5D (RAPG5D) or a pathogen specific antigen.
[00149] [00149] In particular embodiments of any of the articles of manufacture provided, the recombinant receptor is either a T cell receptor or a functional non-T cell receptor. In some embodiments of any of the articles of manufacture provided, the recombinant receptor is a receptor of chimeric antigen (RAQ). In certain embodiments of any of the manufactured articles provided, the RAQ comprises an extracellular antigen recognition domain that specifically binds to the antigen and an intracellular signaling domain comprising an ITAM, where, optionally, the intracellular signaling domain comprises a domain intracellularity of a CD3-zeta (CD37) chain; and / or wherein the RAQ further comprises a co-stimulating signaling region, which optionally comprises a CD28 or 4-1BB signaling domain.
[00150] [00150] In particular embodiments of any of the manufactured articles provided, the modified cells comprise T cells, optionally CD4 * and / or CD8 *. In some embodiments of any of the manufactured articles provided, T cells are primary T cells obtained from an individual. In certain embodiments of any of the articles of manufacture supplied, the dose that is not associated with the risk of developing toxicity or severe toxicity is or comprises less than about 5 x 10 ”total recombinant receptor expression cells, optionally RAQ + cells, T cells total or peripheral whole blood mononuclear cells (PBMCs), as less or less than about 2.5 x 107, less or less than about 1.0 x 107, less or less than about 5.0 x 10º, less or less than about 1.0 x 106, less or less than about 5.0 x 10 or less or less than about 1 x 10 total recombinant receptor expression cells, optionally RAQ * cells, total T cells or cells peripheral whole blood mononuclear cells (PBMCs). In particular embodiments of any of the articles of manufacture provided, the dose that is not associated with the risk of developing toxicity or severe toxicity is or comprises from or about 1 x 10 to 5 x 107 total recombinant receptor expression cells, optionally - cells RAQ ”, total T cells or total peripheral blood mononuclear cells (PBMC), such as 1 x 10º to 2.5 x 107, 1x 10º to 1.0 x 107, 1 x 10º to 5.0 x 106, 1 x 10º to 1.0 x 108, 1.0 x 10º to 5.0 x 105, 5.0 x 10º to 5x 107, 5x 10º to 2.5x 107, 5x 10º to 1.0 x 107, 5x 10º to 5, 0 x 106, 5x 10 ° to 1.0 x 106, 1.0 x 10 ° to 5x 107, 1 x 106 to 2.5 x 107, 1x 10 ° to 1.0 x 107, 1x 10 ° to 5.0 x 1068, 5 , 0x 10º to 5x 107, 5x 10º to 2.5 x 107, 5x 108 to 1.0 x 107, 1.0 x 107 to 5x 107, 1 x 107 to 2.5 x 107 or 2.5 x 107 to 5 x 107 total recombinant receptor expression cells, optionally RAQ * cells, total T cells or total peripheral blood mononuclear cells (PBMC).
[00151] [00151] In certain modalities of any of the manufactured articles provided, the reagent is detectably labeled, optionally marked by fluorescence. In some embodiments of any of the manufactured articles provided, the one or more analyzed (s) is LDH, ferritin, CRP, IL-6, IL-8, I1L-10, TNF-alpha, IFN-alpha2, MCP-1 and MCP-1beta. In particular embodiments of any of the manufactured articles provided, the one or more analyzed (s) is or comprises LDH.
[00152] [00152] Here are provided methods for selecting an individual for treatment, the method comprising: (a) contacting a biological sample with one or more reagents capable of detecting or that is specific to one or more analyzed, where the one or more analyzed (s) is selected from LDH, ferritin, CRP, IL-6, IL-7, IL-8, I1L-10, I1L-15, I1L-16, TNF-alpha, IFN-gamma, MCP-1 , MIP-1beta, eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, IP-10, perforin and D-dimer
[00153] [00153] In certain modalities of any of the methods provided: (a) an individual in (i) is selected to administer to the individual (1) an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating development or risk development of a toxicity and (2) cell therapy, in which administration of the agent must be administered (i) before, (ii) within one, two or three days, (ili) simultaneously with and / or (iv ) in the first fever after starting the administration of cell therapy to the individual; and / or (c) an individual in (i) is selected to give the individual cell therapy at a reduced dose or at a dose that is not associated with the risk of developing toxicity or severe toxicity or is not associated with a risk of developing a severe toxicity or toxicity in most individuals and / or most individuals having a disease or condition in which the individual has, or is suspected of having, after administration of cell therapy; and / or (b) an individual in (i) is selected to administer to the individual cell therapy in a hospital setting and / or with admission to the hospital for one or more days, optionally in which cell therapy should otherwise be administered outpatients or without admission to the hospital for one or more days.
[00154] [00154] In some modalities of any of the methods provided, an individual in (i) is selected, and the method further comprises: (a) administering to the individual (1) an agent or other treatment capable of treating, preventing, delaying, reducing or mitigate the development or risk of developing a toxicity and (2) cell therapy, in which administration of the agent is performed (i) before, (ii) within one, two or three days, (ili)) concomitantly with and / or (iv) in the first fever after starting the administration of cell therapy to the individual; and / or (b) giving the individual cell therapy at a reduced dose or at a dose that is not associated with the risk of developing serious toxicity or toxicity, or is not associated with the risk of developing severe toxicity or toxicity in most individuals, and / or in most individuals having a disease or condition in which the individual has, or is suspected of having, after administration of cell therapy; and / or (c) administering to the individual cell therapy or a dose of genetically modified cells from cell therapy that is not associated with the risk of developing toxicity or severe toxicity, or is not associated with the risk of developing toxicity or severe toxicity in the most individuals and / or most individuals having a disease or condition in which the individual has, or is suspected of having, after administration of cell therapy; and / or (d) administering cell therapy to the individual in a hospital setting and / or with admission to the hospital for one or more days, optionally in which cell therapy should otherwise be administered to patients on an outpatient basis or without admission to the hospital by a or more days.
[00155] [00155] In particular modalities of any of the methods provided: (a) an individual in (ii) is selected to administer to the individual cell therapy, optionally in a non-reduced dose, optionally on an outpatient basis or without admission to the hospital for one or more days ; (b) an individual in (ii) is selected to administer to the individual cellular therapy, in which the cellular therapy does not comprise the administration, before or simultaneously with the administration of the cellular therapy and / or before the development of a sign or symptom of a toxicity other than fever, an agent or treatment capable of treating, preventing, delaying or mitigating the development of toxicity; and / or an individual in (ii) is selected to administer cell therapy on an outpatient basis and / or without admission of the individual to the hospital overnight or for one or more consecutive days and / or without admission of the individual to the hospital for one or more days .
[00156] [00156] In certain modalities of any of the methods provided, an individual in (ii) is selected, and the method further comprises administering to the individual cell therapy, optionally in a non-reduced dose, optionally on an outpatient basis or without admission to the hospital by one or more days. In some modalities of any of the methods provided, an individual in (ii) is selected, and the method further comprises administering to the individual cell therapy, in which: administration of cell therapy does not include administration, either before or concurrently with administration of therapy cellular and / or before the development of a sign or symptom of a toxicity other than fever, an agent or treatment capable of treating, preventing, delaying or mitigating the development of toxicity; and / or the administration of cell therapy must be or can be administered to the individual on an outpatient basis and / or without admission of the individual to the hospital overnight or for one or more consecutive days and / or without admission of the individual to the hospital for one or more days .
[00157] [00157] A treatment method is provided here, comprising: (a) analyzing a biological sample for the level, quantity or concentration of one or more analyzed, in which the biological sample is from an individual who is a candidate for treatment, optionally with a cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells that express a recombinant receptor for the treatment of a disease or condition, wherein the one or more analyzed (s) is selected from LDH, ferritin , CRP, IL-6, IL-7, IL-7, IL-8, II-10, IL-15, IL-16, TNF-alpha, IFN-gamma, MCP-1, MIP-1 beta, eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, IP-10, perforin and D-dimer (fibrin degradation product); and (b) follow or rely on the results of the trial, administer to the individual cell therapy and, optionally, an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity.
[00158] [00158] A treatment method is provided here, comprising, following or based on the results of an assay, of a biological sample from an individual, for the level, quantity or concentration of one or more analyzed, administering to the individual (i) a cell therapy, optionally comprising a dose or genetic engineering composition that expresses a recombinant receptor for the treatment of a disease or condition and, optionally, (ii) an agent or other treatment capable of treating, preventing, delaying, reducing or attenuating the development or risk of developing a toxicity, in which: the biological sample is obtained from the individual before the administration of cell therapy; and the one or more analyzed is selected from LDH, ferritin, CRP, IL-6, IL-7, IL-8, I1L-10, IL-15, I1L-16, TNF-alpha, IFN-gamma, MCP-1 , MIP-1beta,
[00159] [00159] In particular modalities of any of the methods provided, the said test comprises detection which optionally comprises contacting a reagent capable of directly or indirectly detecting the one analyzed with the biological sample and determining the level, quantity or concentration of the one analyzed in the biological sample. In certain modalities of any of the methods provided, if the level, quantity or concentration of the analyte in the sample is equal to or above a threshold level: administer to the individual the agent or other treatment capable of treating, preventing, delaying, reducing or attenuating the development or risk of developing toxicity (i) before, (ii) within one, two or three days, (ili) simultaneously with and / or (iv) in the first fever after the start of administration of cell therapy to the individual; and / or administer cell therapy to the individual at a reduced dose or at a dose that is not associated with the risk of developing serious toxicity or toxicity, or is not associated with the risk of developing severe toxicity or toxicity in most individuals, and / or in most individuals having a disease or condition in which the individual has, or is suspected of having, after administration of cell therapy; and / or administering cell therapy to the individual in a hospital setting and / or with admission to the hospital for one or more days, optionally where cell therapy should otherwise be administered to individuals on an outpatient basis or without admission to the hospital by one or more days.
[00160] [00160] In some modalities of any of the methods provided, if the level, quantity or concentration of the analyzed is at a level or above a threshold level: the administration of cell therapy does not include the administration, before or simultaneously with the administration of cell therapy and / or before the development of a sign or symptom of a toxicity other than fever, an agent or treatment capable of treating, preventing, delaying or mitigating the development of toxicity; and / or the administration of cell therapy must be or can be administered to the individual on an outpatient basis and / or without admission of the individual to the hospital overnight or for one or more consecutive days and / or without admission of the individual to the hospital for one or more days .
[00161] [00161] In particular modalities of any of the methods provided, administer to an individual, an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity, in which: the individual is a candidate for treatment optionally with cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells that express a recombinant receptor for the treatment of a disease or condition; and the individual was identified as at risk of developing toxicity after or based on the results of an assay, of a biological sample from an individual, for the level, quantity or concentration of one or more analyzed, said biological sample obtained from the individual before administration of cell therapy and / or said biological sample that does not comprise the recombinant receptor and / or said modified cells, where the one or more analyzed (s) is selected from LDH, ferritin, CRP, IL-6, IL-7, IL-8, IL-10, IL-15, IL-16, TNF-alpha, IFN-gamma, MCP-1, MIP-1beta, eotaxin, G-CSF, IL-1Ralpha, IL-1Rbeta, IP-10, perforin, and D-dimer (fibrin degradation product).
[00162] [00162] In certain modalities of any of the methods provided, the said test comprises detection which optionally comprises contacting a reagent capable of directly or indirectly detecting the analysis with the biological sample and determining the level,
[00163] [00163] In particular modalities of any of the methods provided, the agent is administered (i) before, (ii) within one, two or three days, (ii) simultaneously with and / or (iv) in the first fever following the start of administration of cell therapy to the individual. In certain modalities of any of the methods provided, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% of the percentage or average number and / or within a deviation percentage or average number of positive cells on the surface for the myeloid marker in a biological sample obtained from a group of individuals before receiving a therapeutic cell composition of recombinant receptor expression, in which each individual in the group developed a toxicity after receiving a therapeutic cell composition of recombinant receptor expression for the treatment of the same disease or condition.
[00164] [00164] In particular modalities of any of the methods provided, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% of the average level, quantity or concentration, and / or is within a standard deviation of the mean level, quantity or concentration, of that analyzed in a biological sample obtained from a group of individuals before receiving a therapeutic cellular composition of expression of the recombinant receptor, in which each individual in the group developed a toxicity after receiving a therapeutic cell composition of recombinant receptor expression for the treatment of the same disease or condition. In certain embodiments of any of the methods provided, the reagent is a binding molecule that specifically binds to the marker or cells in the myeloid cell population. In some embodiments of any of the methods provided, the reagent is an antibody or antigen-binding fragment thereof. In particular embodiments of any of the methods provided, the biological sample is or is obtained from a blood, plasma or serum sample. In certain modalities of any of the methods provided, analyzing or evaluating cells, the analyte comprises an immunoassay.
[00165] [00165] In some modalities of any of the methods provided, the toxicity comprises neurotoxicity or cytokine release syndrome (SLC), optionally grade 1 or higher neurotoxicity or SLC. In particular modalities of any of the methods provided: the toxicity comprises severe neurotoxicity and / or comprises a neurotoxicity of grade 2 or higher, a neurotoxicity of grade 3 or higher, at least a prolonged grade 3 neurotoxicity or is equal to or greater than the neurotoxicity of grade 4 or 5; and / or the toxicity comprises severe SLC and / or comprises SLC of grade 2 or higher or 3 or higher. In certain modalities of any of the methods provided, toxicity is associated with cerebral edema.
[00166] [00166] In some embodiments of any of the methods provided, the agent or other treatment is or comprises one or more of a steroid; a cytokine or cytokine receptor antagonist or inhibitor selected from IL-10, IL-10R, IL-6, IL-6 receptor, IFNy, IFNGR, IL-2, IL-2R / CD25, MCP-1, CCR2 , CCRA4, MIP1B, CCRS5, TNFalpha, TNFR1, IL-1 and IL-1Ralfa / IL-1beta; or an agent capable of preventing, blocking or reducing the activity or function of microglial cells. In particular embodiments of any of the methods provided, the antagonist or inhibitor is or comprises an agent selected from an antibody or antigen binding fragment, a small molecule, a protein or peptide and a nucleic acid.
[00167] [00167] In certain embodiments of any of the methods provided, the agent or other treatment is an anti-IL-6 antibody or an anti-| IL6 receptor antibody. In some embodiments of any of the methods provided, the agent or other treatment is or comprises an agent selected from tocilizumab, siltuximab, clazakizumab, sarilumab, olokizumab (CDP6038), elsilimomabe, ALD5S18 / BMS-945429, sirukumabe (CNTO 136), CPSI- 2634, CPSI-2634, ARGX-109, FE301 and FM101. In modalities of any of the methods provided, the agent or other treatment is or comprises tocilizumab. In certain embodiments of any of the methods provided, the agent or other treatment is or comprises siltuximab.
[00168] [00168] In some embodiments of any of the methods provided, the steroid is or comprises dexamethasone. In particular modalities of any of the methods provided, the agent capable of preventing, blocking or reducing the activity or function of microglial cells is selected from an anti-inflammatory agent, a NADPH oxidase inhibitor (NOX2), a calcium, a sodium channel blocker, inhibits GM-CSF, inhibits CS FI1IR, specifically binds to CSF-1, specifically binds to IL-34, inhibits the activation of nuclear factor cover B (NF-KB), activates a CB2 receptor and / or is a CB2 agonist, a phosphodiesterase inhibitor, inhibits microRNA-155 (miR-155) or over-regulates microRNA-124 (miR-124).
[00169] [00169] In certain embodiments of any of the methods provided, the agent capable of preventing, blocking or reducing the activation or function of microglial cells is a small molecule, peptide,
[00170] [00170] In particular embodiments of any of the methods provided, the agent is an inhibitor of the colony stimulating factor 1 receptor (CSFIR). In certain modalities of any of the methods provided, the inhibitor is selected from: PLX-3397, PLX647, PLX108-D1, PLX7486, JNJ-40346527, JNJ28312141, ARRY- 382, AC-708, DCC-3014, 5- (3) -methoxy-4 - ((4-methoxybenzyl) oxy) benzyl) pyrimidine-2,4-diamine (GW2580), AZD6495, Ki20227, BLZ945 or a pharmaceutical or prodrug salt thereof; emactuzumab, IMC-CS4, FPAOO8, LY-3022855, AMG-820 and TG-3003 or is an antigen-binding fragment thereof; or a combination of any of the above.
[00171] [00171] In some embodiments of any of the methods provided, the inhibitor is PLX-3397. In particular embodiments of any of the methods provided, the recombinant receptor specifically binds to an antigen associated with the disease or condition or expressed in the cells of the environment of an injury associated with the disease or condition. In certain modalities of any of the methods provided, the disease or condition is a cancer. In some modalities of any of the methods provided, the disease or condition is a myeloma, leukemia or lymphoma. In particular modalities of any of the methods provided, the disease or condition is a B-cell malignancy and / or is acute lymphoblastic leukemia (ALL), adult ALL, chronic lymphoblastic leukemia (LLC), non-Hodgkin's lymphoma (NHL) and diffuse lymphoma Large B Cell (LDGCB).
[00172] [00172] In certain modalities of any of the methods provided, the antigen is ROR1, B cell maturation antigen (BCMA), carbonic anhydrase 9 (CAIX), tEGFR, Her2 / neu (erbB2 receptor tyrosine kinase), LI-CAM, CD19, CD20, CD22, mesothelin, CEA and hepatitis B surface antigen, antifolate receptor, CD23, CD24, CD30, CD33, CD38, CD44, EGFR, epithelial glycoprotein 2 (GEP-2), epithelial glycoprotein 40 (GEP-40 ), EPHa2, erb-B2, erb-B3, erb-B4, erbB, EGFR vill, folate-binding protein (FBP), FCRL5, FCRH5, fetal acetylcholine receptor, GD2, GD3, HMW-MAA, IL- 22R-alpha, I1L-13R-alpha2, kinase insertion domain receptor (Kkdr), kappa light chain, Lewis Y, L1 cell adhesion molecule, (LI-CAM), melanoma-associated antigen (MAGE) -A1 , MAGE-A3, MAGE-A6, preferably expressed melanoma antigen (AMEPE), survivin, TAG72, B7-H6, 11-13 alpha-13 receptor (IL-13Ra2), CA9, GD3, HMW-MAA, CD171, G250 / CAIX, HLA-Al MAGE Al, HLA-A2 NY-ESO-1, PSCA, d receptor and folate, CD44v6, CD44v7 / 8, integrin avb6, 8H9, NCAM, VEGF receptors, 5T4, AchR fetal, NKG2D ligands, CD44v6, dual antigen, testicular cancer antigen, mesothelin, murine CMV, mucin 1 (MUC1) , MUC16, PSCA, NKG2D, NY-ESO-1, MART-1, gp100, oncofetal antigen, ROR1, TAG72, VEGF-R2, carcinoembryonic antigen (CEA), Her2 / neu, estrogen receptor, progesterone receptor, ephrinB2, CD123, c-Met, GD-2, acetylated GD2 (GD20), CE7, Wilms Tumor 1 (WT-1), a cyclin, cyclin A2, CCL-1, CD138, Receptor Coupled to
[00173] [00173] In some embodiments of any of the methods provided, the recombinant receptor is either a T cell receptor or a functional non-T cell receptor. In particular embodiments of any of the methods provided, the recombinant receptor is a chimeric antigen receptor (RAQ ). In certain embodiments of any of the methods provided, the RAQ comprises an extracellular antigen recognition domain that specifically binds to the antigen and an intracellular signaling domain comprising an ITAM, where optionally, the intracellular signaling domain comprises an intracellular domain of a CD3-zeta chain (CD3 €); and / or wherein the RAQ further comprises a co-stimulating signaling region, which optionally comprises a CD28 or 4-1BB signaling domain.
[00174] [00174] In some embodiments of any of the methods provided, the modified cells comprise T cells, optionally CD4 * and / or CD8 *. In particular embodiments of any of the methods provided, T cells are primary T cells obtained from an individual. In certain embodiments of any of the methods provided, cell therapy comprises the administration of about 1 x 10 th to 1 x 10 th total recombinant receptor expression cells, total T cells or peripheral whole blood mononuclear cells (PBMC), or of about 5 x 10 th to 1 x 10 7 total recombinant receptor expression cells, total T cells or total blood mononuclear cells (PBMC) or from or about 1 x 106 ° to 1 x 107 total recombinant receptor expression cells, T cells total or total peripheral blood mononuclear cells (PBMC), each inclusive.
[00175] [00175] In some embodiments of any of the methods provided, cell therapy comprises the administration of no more than 1 x 108 total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMC), no more than than 1 x 107 total recombinant receptor expression cells, total T cells or total blood mononuclear cells (PBMC), not more than 0.5 x 107 total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMC), no more than 1 x 1086 total recombinant receptor expression cells, total T cells or total blood mononuclear cells (PBMCs), no more than 0.5 x 10th total recombinant receptor expression cells, T cells total or peripheral whole blood mononuclear cells (PBMC).
[00176] [00176] In particular modalities of any of the methods provided, the dose that is not associated with the risk of developing serious toxicity or toxicity is or comprises less than or less than about 5 x 10 th total recombinant receptor expression cells, optionally RAQ cells ”, Total T cells or peripheral whole blood mononuclear cells (PBMC), such as less than or less than about 2.5 x 107, less or less than about 1.0 x 107, less than or less than 5.0 x 10º , less or less than about 1.0 x 10º, less or less than about 5.0 x 10º or less or less than about 1 x 10º total recombinant receptor expression cells, optionally RAQ * cells, total T cells or peripheral whole blood mononuclear cells (PBMCs).
[00177] [00177] In certain modalities of any of the methods provided, the dose that is not associated with the risk of developing serious toxicity or toxicity is or comprises from or about 1 x 10 to 5 x 107 total recombinant receptor expression cells, optionally cells RAQ +, total T cells or total peripheral blood mononuclear cells (PBMC), such as 1 x 10º to 2.5x 107, 1x 10º to 1.0 x 107, 1 x 10º to 5.0 x 106, 1 x 10º to 1 , 0 x 108, 1.0 x 10º to 5.0 x 105, 5.0 x 10º to 5x 107, 5x 10º to 2.5x 107, 5x 10º to 1.0 x 107, 5x 10º to 5.0 x 106, 5x 10 ° to 1.0 x 106, 1.0 x 10 ° to 5x 107, 1 x 10 ° to 2.5 x 107, 1x 106 to 1.0 x 107, 1x 10 ° to 5.0 x 106, 5.0 x 10º to 5x 107, 5x 106 to 2.5 x 107, 5x 10º to 1.0 x 107, 1.0 x 107 to 5x 107, 1 x 107 to 2.5 x 107 or 2.5 x 107 to 5 x 107 total recombinant receptor expression cells, optionally RAQ cells ”, total T cells or total peripheral blood mononuclear cells (PBMC)) In some embodiments of any of the methods provided, the cells modified squid are autologous to the individual. In particular modalities of any of the methods provided, the modified cells are allogeneic to the individual. In certain embodiments of any of the methods provided, the reagent is detectably labeled, optionally fluorescently labeled.
[00178] [00178] In some modalities, the instructions provide information on a threshold level, individually for each of the one or more analyzed, which is indicative of the probability of an individual to exhibit a response to treatment with cell therapy. In some embodiments, the instructions provide information on a threshold level, individually for each or more analyzed, which is indicative of the likelihood that an individual will exhibit a durable response after administration of cell therapy. In some modalities, the instructions provide information on a threshold level, individually for each or more analyzed, which is indicative of an individual's likelihood of showing toxicity after administration of cell therapy.
[00179] [00179] FIG. 1 shows the percentage of individuals who experienced laboratory abnormalities and adverse treatment emergent events (TEAEs) that occurred in 2 20% of individuals. *: A Grade 5 EA of multiple organ failure not related to the study of treatment and due to the progression of lymphoma; 1: A Grade 5 EA of diffuse alveolar damage, investigator assessed to be related to fludarabine, cyclophosphamide and RAQ T cell therapy, which occurred on day 23 in an individual who refused mechanical ventilation for progressive respiratory failure while neutropenic in growth factors and antibiotics broad-spectrum and antifungal agents
[00180] [00180] FIG. 2 is a Kaplan meier curve that describes the time observed for the onset of SLC and neurotoxicity.
[00181] [00181] AFIG.3A and FlIG.3B describe three-month objective response rates (ORT) among subgroups of treated individuals.
[00182] [00182] FIG. 4A and FIG4B show the duration of the response (CR / PR, RC or RP) and overall survival in the main and complete cohort of individuals.
[00183] [00183] AFIG.5A shows the pharmacokinetics of RAQ * T cells in peripheral blood at various times after treatment at different dose levels. FIG. 5B shows the pharmacokinetics of RAQ * T cells in peripheral blood at various times after treatment between responders and non-responders. FIG. 5C shows the pharmacokinetics of RAQ * T cells in peripheral blood at various times after treatment in individuals who have developed or have not developed neurotoxicity.
[00184] [00184] FIG. 6A shows the number of CD3 * / RAQ, CDA4 * / RAQ *, CD8 * / RAQ * T cells in the peripheral blood of an individual with transformed chemoreceptor LDGCB measured at certain times. FIG. 6B represents an axial pre-treatment PET-CT image showing an intracranial abnormality in the right middle cranial fossa and an extensive abnormality in the subcutaneous tissues in the right posterior auricular region. FIG. 6C is a post-treatment PET-CT image depicting the resolution of the abnormality in FIG. 2B after treatment with anti-CD19 * RAQ T cells. FIG. 6D is a pre-treatment brain MRI (high-resolution T1-weighted image using contrast material; axial view) showing a homogeneous enhancement mass in the right middle cranial fossa. FIG. 6E is a post-treatment MRI image showing an almost complete resolution of the enhancement mass. FIG. 6F is an axial PET-CT image in recurrence showing recurrence of the right posterior atrial tumor associated with intense uptake of * ºF-flurodeoxyglucose (arrow). FIG. 6G is a PET-CT image showing resolution of the posterior auricular tumor after incisional biopsy and reexpansion of RAQ T cells *.
[00185] [00185] FIG.7 shows analyte levels measured in the serum of individuals prior to administration of RAQ * T cells and correlation with the development of neurotoxicity.
[00186] [00186] FIG. 8 shows a graph plotting the progression-free time (months) and indicating the best overall response and durability of the response, and the individual clinical results observed over time in individuals in a Complete cohort and a Main cohort of individuals with NHL treated with anti-cCD19 cell therapy containing CD4 * and CD8 * T cells of RAQ-T expression. *: Patients reached BOR in month 1, except where otherwise indicated; º: Complete resolution of CNS involvement due to lymphoma observed in 2 patients; º: A patient re-expanded after biopsy in disease progression
[00187] [00187] FIG. 9A describes the median number (t quartiles) of CD3 * cells of blood RAQ / UL expression, assessed by flow cytometry using an antibody specific for a truncated receptor (CD3, circle; N = 87); or mean number (+ quartiles) of copies of integrated RAQ transgene / ug of genomic DNA, assessed by quantitative polymerase chain reaction (qPCR) using specific primers for a post-transcriptional regulatory element of the groundhog hepatitis virus (WPRE) present in the vector encoding the RAQ (gPCR, square; N = 85) in blood samples from 87 individuals who were administered with anti-CD19 RAQ expression cells. The cut-off point for detecting RAQ * cells in flow cytometry was established at 2 25 events in the RAQ channel ”*, and the detection limit for qPCR was> 12.5 copies of the RAQ transgene per ug of genomic DNA.
[00188] [00188] FIG. 9B describes the relative number of CD4 * and CD8 * / uL RAQ expression cells in blood and bone marrow samples from 67 subjects who were administered anti-CD19 RAQ expression cells on day 11 + 3 days. The line represents the unit line and is not a regression line.
[00189] [00189] FIGS.10A and 10B describe the median area (+ quartiles) under the curve between days O and 28 (AUCo-28; FIG. 10A) and the maximum serum concentration (Cmax; RAQ * cells / uL of blood ; FIG. 10B) of RAQ * CD4 * and CD8 * cells in subgroups of individuals with diffuse large B cell lymphoma de novo or transformed into indolent lymphoma (LDGCB, NOS; N = 27), transformed follicular lymphoma (tLF; N = 10), LDGCB transformed from marginal zone lymphoma or chronic lymphocytic leukemia (tMZL / tLLC; N = 4) or lining cell lymphoma (LCR; N-5), which received RAQ expression T cells in ND1.
[00190] [00190] FIGS.11A and 11B describe the median area (+ quartiles) under the curve between days O and 28 (AUCo-28; FIG. 11A) and the maximum serum concentration (Cmax; RAQ * cells / UuL of blood ; FIG. 11B) of RAQ * CD3 *, CD4 * and CD8 * cells in individuals who received RAQ * cells in ND1 or ND 2.
[00191] [00191] FIGS. 12A-12D describe the median number (t + quartiles) of RAQ * CD4 * and CD8 * cells of blood RAQ / UL expression over time, in individuals who developed cytokine release syndrome (any SLC) compared to individuals who did not develop SLC (without SLC) (CD4 *: FIG. 12A; CD8 *: FIG. 12B) or in individuals who developed neurotoxicity (any NT) compared to individuals who did not develop NT (without NT) (CD4 *: FIG 12C; CD8 *: FIG. 12D).
[00192] [00192] FIGS.13Ae13B describe the number of RAQ * CD3 * peak cells / ul (CD3 * Cmax) in individuals grouped by individuals who had the best overall response (MRG) of RC, RP or DP or a durable response 3 months (M3) of RC, RP or PD.
[00193] [00193] AFIG.14A describes the levels of analyzed in pre-lymphodepletion blood in serum samples from individuals who exhibited high RAQ * cell expansion (CD3 * Cmax *> 500) and individuals who exhibited low RAQ * cell expansion (Cmax) CD3 * <500).
[00194] [00194] FIG. 14B describes the peak levels of blood analyte in serum samples from individuals who exhibited high RAQ * cell expansion (CD3 * Cmax *> 500) and individuals who exhibited low RAQ * cell expansion (CD3 * Cmax * <500) .
[00195] [00195] FIG. 15 depicts a graph depicting pre-lymphopletion SDP (cm ) Against AUCo-28 (cells * day / uL) of RAQ * CD3 * cells, for individuals administered with ND1 or ND2 cells of RAQ cells " .
[00196] [00196] FIGS.16A and16B describe the levels of analyzed in pre-lymphodepletion blood in serum samples from individuals who developed cytokine release syndrome (SLC grade 1 - 4) compared to individuals who did not develop SLC (SLC grade O ) (FIG. 16A) or in individuals who developed neurotoxicity (NT grade 0) compared to individuals who did not develop NT (NT grade 1 - 4) (FIG. 16B). The units were: Ferritin and D-dimer (vg / L); PCR (mg / L) and cytokines (pg / mL).
[00197] [00197] AFIG.17 describes the evaluation of the sum of the parameters of the pre-lymphodepletion patient of the product dimensions (SPD; cm ), Indicative of the tumor load and the lactate dehydrogenase level (LDH; U / L), in individuals who developed cytokine release syndrome (any SLC) compared to individuals who did not develop SLC (without SLC) or in individuals who developed neurotoxicity (any NT) compared to individuals who did not develop NT (without NT).
[00198] [00198] FIG. 18A is a graph depicting pre-lymphodepletion SPD (cm ) Against pre-lymphodepletion LDH (U / L), in individuals who developed neurotoxicity (NT Grade 1 - 4) or individuals who did not develop NT (NT Grade O) (panel left) and in individuals who developed SLC (SLC Grade 1 - 4) or individuals who did not develop SLC (SLC Grade 0) (right panel). Dotted lines represent levels of SDP (50 cm Or higher) or LDH (500 U / L or higher) that are associated with higher rates of SLC or NT. FIG. 18B represents the estimates of probability relationships to develop SLC or NT based on the levels of SDP (50 cm Or higher) or LDH (500 U / L or higher), with 95% confidence intervals (CI). FIG. 18C describes the probability relationship estimates for the development of SLC or NT based on SDP or LDH levels, including the probability relationship estimates for values below the limit, with 95% confidence intervals (CI).
[00199] [00199] FIG.19 represents the pre-lymphodepletion tumor burden (SDP) parameter and blood levels analyzed for individuals who had a durable response in 3 months versus for individuals who had no response in 3 months. The units were: Ferritin and D-dimer (ug / L); PCR and SAA-1 (mg / L) and cytokines (pg / mL).
[00200] [00200] FIGS.20A and 20B describe peak blood analyte levels in serum samples from individuals who developed cytokine release syndrome (any SLC) compared to individuals who did not develop SLC (without SLC) (FIG. 20A ) or in individuals who developed neurotoxicity (any NT) compared to individuals who did not develop NT (without NT) (FIG. 20B). The units were: PCR (mg / L), SAA-1 (mg / L) and cytokines (Po / mL).
[00201] [00201] FIG. 21A describes the maximum blood levels analyzed in serum samples from individuals who had the best overall response (MRG) of complete response (RC) or partial response (PR) (N = 57) compared to levels in subjects who had stable disease (ED) or progressive disease (PD) (N = 17). FIG. 21B describes the maximum blood levels analyzed in serum samples from individuals who had an ED / DP response in three months (N = 31), compared to individuals who had a CR / PR response in three months (N = 35). The units were: PCR (mg / L), SAA-1 (mg / L) and cytokines (pg / mL).
[00202] [00202] FIG. 22 represents the 3-month objective response rates (ORT) among the subgroups of treated individuals, with a 95% confidence interval.
[00203] [00203] FIGS.23A and 23B represent the duration of the response (DOR) for the complete cohort (FIG. 23A) and the main cohort (FIG. 23B) and FIGS. 23C and 23D describe the overall survival for the complete cohort (FIG. 23C) and the main cohort (FIG. 23D), for subjects who achieved CR, PR, all subjects who responded, non-responders and all treated subjects. The median F / U was 6.3 months for the duration of the response.
[00204] [00204] FIG. 24 shows the percentage of individuals who experienced treatment-emergent adverse events (TEAEs) in the COMPLETE LDGCB cohort occurring in> 20% of patients. Data from 5 patients with LCM treated with product conforming to ND1 with at least 28 days of follow-up were not included. º: A grade 5 septic shock AE not related to the administration of RAQ T cells *. º ": A grade 5 AE of diffuse alveolar damage, investigator assessed as related to fludarabine, cyclophosphamide and RAQ T cells *, which occurred on day 23 in a patient who refused mechanical ventilation for progressive respiratory failure while neutropenic in growth factors and antibiotics of broad spectrum and antifungals. *: Laboratory abnormalities.
[00205] [00205] FIG. 25 shows the percentage of individuals who developed SLC or neurotoxicity over time, in the complete cohort.
[00206] [00206] FIG.26 shows box plots showing the T cell purity of the enriched T cell compositions for CD4 * and CD8 * 'cells at different stages of the process to generate modified cell compositions containing RAQ T cells, which is described in Example 8. The frequency (% of total leukocytes) of CD4 * and CD8 * cells in the compositions is shown.
[00207] [00207] FIGS. 27A-27C show box plots showing the concentration (FIG. 27A), viability (FIG. 27B) and frequency of caspase-3 negative T cells (FIG. 27C) CD4 * and CD8 * RAQ * in therapeutic cell compositions of a high or low formulation volume.
[00208] [00208] FIG. 28A shows the number of CD3 * RAQ * T cells present in the RAQ T cell compositions for administration in ND1 and ND 2. FIG. 28B shows the number of CD4 * RAQ * and CD8 * RAQ * cells and CD4 * RAQ * TNF-a0 * cells and CD8 * RAQ * TNF-a * cells
[00209] [00209] FIG. 29 shows the percentage of individuals who experienced treatment-emergent adverse events (TEAEs) in the FULL LDGCB cohort occurring in> 20% of the individual at one point in the study described in Example 6. Data for 6 individuals with LCM treated with conformant product in ND1 with at least 28 days of follow-up was not included. *: A grade 5 septic shock AE unrelated to the administration of RAQ T cells ”, which occurred in the course of disease progression. º ": A grade 5 of diffuse alveolar damage, investigator evaluated as related to fludarabine, cyclophosphamide and RAQ T cells *, occurred on the 23rd in a patient who refused mechanical ventilation for progressive respiratory failure while neutropenic in growth factors and antibiotics of broad spectrum and antifungals. *: Laboratory abnormalities.
[00210] [00210] AFIG.30 describes the objective response rates (ORT) of six (6) months among the subgroups of treated individuals, with a 95% confidence interval. “It includes all individuals with LDGCB treated at all dose levels in the CORE cohort.
[00211] [00211] FIGS. 31A and 31B describe the duration of the response (DOR) for the complete cohort (FIG. 31A) and the main cohort (FIG. 31B) and FIGS. 31C and 31D represent the overall survival of the complete cohort (FIG. 31C) and the main cohort (FIG. 31D), for individuals who achieved CR, PR, all individuals who responded, non-responders and all treated individuals. NE, not calculable. Detailed Description |. METHODS AND USES OF CELLULAR CELL THERAPY GENETICALLY MODIFIED
[00212] [00212] Modified cell methods and uses (for example, T cells) and / or compositions thereof are provided for the treatment of individuals with a disease or condition, which is usually or includes a cancer or tumor, such as leukemia or a lymphoma, more particularly a non-Hodgkin's lymphoma (NHL). In some respects, the methods and uses provide or achieve improved response and / or more durable responses or efficacy and / or reduced risk of toxicity or other side effects, for example, in particular groups of treated individuals, compared to certain alternative methods.
[00213] [00213] In some embodiments, the methods and uses include administering to the individual cells that express genetically modified (recombinant) cell surface receptors in adoptive cell therapy, which are generally chimeric receptors, such as chimeric antigen receptors (RAQs), recognizing an antigen expressed by, associated and / or specific to leukemia or lymphoma and / or cell type from which it is derived. The cells are generally administered in a composition formulated for administration; the methods generally involve administering one or more doses of cells to the individual, the dose (s) of which may include a particular number or relative number of cells or modified cells and / or a defined ratio or compositions of two or more subtypes within the composition, such as CD4 vs. CD8 T cells.
[00214] [00214] In some embodiments, cells, populations and compositions are administered to an individual having the particular disease or condition to be treated, for example, via adoptive cell therapy, such as adoptive T cell therapy. In some embodiments, the methods involve treating an individual having lymphoma or leukemia, such as non-Hodgkin's lymphoma (NHL) with a dose of antigen receptor expression cells (for example, RAQ expression cells).
[00215] [00215] In some modalities, the methods provided involve the treatment of a specific group or subset of individuals, for example, individuals identified as having high risk disease, for example, high risk NHL. In some ways, the methods treat individuals with a form of non-Hodgkin's lymphoma (NHL) with an aggressive and / or poor prognosis, such as the NHL that has relapsed or is refractory (R / R) to standard therapy has a poor prognosis. In some cases, the overall response rate (TRG; also known in some cases as the objective response rate) to available therapies, a standard of care, or a reference therapy for the disease and / or patient population for which therapy is indicated, is less than 40% and the complete response (CR; also known in some cases as complete remission) is less than 20%. In some modalities, in chemo-refractory LDGCB, the RRT with a reference or available treatment or standard care therapy is around 26% and the CR rate is around 8% (Crump et al. Outomes in refractory aggressive diffuse large B-cell lykvmphoma (LDGCB): Results of the international SCHOLAR study (ASCO 2016 [Abstract 7516]). In some respects, the methods, compositions, uses and articles of manufacture provided achieve improved and superior responses to available therapies.
[00216] [00216] In some embodiments, the methods, uses and articles of manufacture involve or are used for the treatment of individuals involving, selecting or identifying a particular group or subset of individuals, for example, based on specific types of disease, criteria for diagnosis, previous treatments and / or response to previous treatments. In some modalities, the methods involve the treatment of an individual who relapsed after remission after treatment with, or becomes refractory to, one or more previous therapies; or an individual who has relapsed or is refractory (R / R) to one or more previous therapies, for example, one or more standard therapy lines. In some modalities, the methods involve treating individuals with diffuse large B cell lymphoma (LDGCB), not otherwise specified (NOS; again and turned into indolent), primary mediastinal B cell lymphoma (LCBMP) or follicular lymphoma , as grade 3B follicular lymphoma (LF3B). In some modalities, the methods involve treating an individual who has an Eastern Cooperative Oncology Group Performance Status (ECOG) of 0-1 or 0-2. In some modalities, the methods treat a population with poor prognosis or patients with LDGCB or an individual who generally responds poorly to particular reference therapies or therapies, such as one that has one or more, like two or three, chromosomal translocations (as called lymphoma) "double hit" or "triple hif"; having MYC / 8g924 translocations locus, usually in combination with the t (14; 18) (932; 921) bcl-2 or / and BCL6 / 3927 chromosomal translocation; see, for example, Xu et al. (2013) Int J Clin Exp Pathol. 6 (4): 788— 794) and / or one who had relapsed, optionally relapsed within 12 months after administration of an autologous stem cell transplant (TACT) and / or one that has been deemed to be chemo-refractory.
[00217] [00217] In some respects, the modalities provided are based on observations that the methods provided can be used to achieve a high response rate with high durability, compared to certain methods available for cell therapy, without an increased risk of toxicity. In some modalities, the methods provided allow prolonged persistence of cells adopted for cell therapy and / or low rate of development of toxicity in the individual. In some embodiments, the methods can be used to select individuals for treatment with cell therapy likely or more likely to respond to therapy and / or determine appropriate doses or dosing regimens for higher response rates and / or more durable response, while minimizing the risk of toxicity. Such methods can inform rational strategies to facilitate the safe and effective clinical application of adoptive cell therapy, such as RAQ-T cell therapy.
[00218] [00218] In some embodiments, the antigen receptor (for example, RAQ) binds specifically to a target antigen associated with the disease or condition, as associated with NHL. In some modalities, the antigen associated with the disease or disorder is selected from among CD20, CD19, CD22, ROR1, CD45, CD21, CD5, CD33, Igcapa, Iglambda, CD79a, CD79b or CD30.
[00219] [00219] In some embodiments, the methods include administering the cells or a composition containing the cells to an individual, tissue or cell, such as a person who has, is at risk or suspected of having the disease, condition or disorder. In some modalities, the individual is the individual is an adult. In some modalities, the individual is over 30, 40, 50, 60 or 70 years old.
[00220] [00220] In some embodiments, the methods include administering cells to an individual selected or identified as having a certain prognosis or risk of NHL. Non-Hodgkin's lymphoma (NHL) is a variable disease. Some individuals with NHL may survive without treatment, while others may require immediate intervention. In some cases, individuals with NHL can be classified into groups that can inform the prognosis of the disease and / or the recommended treatment strategy. In some cases, these groups can be "low risk", "intermediate risk", "high risk" and / or "very high risk" and patients can be classified as such, depending on several factors, including, among others, genetic anomalies and / or morphological or physical characteristics. In some modalities, individuals treated according to methods and / or articles of manufacture or compositions are classified or identified based on the risk of NHL. In some modalities, the individual is the one who has high-risk NHL.
[00221] [00221] In some embodiments, the individual has previously been treated with a therapy or therapeutic agent targeting the disease or condition, for example, NHL, before administration of the cells expressing the recombinant receptor. In some modalities, the individual has previously been treated with a hematopoietic stem cell transplant (HSCT), for example, allogeneic HSCT or autogenic HSCT. In some modalities, the individual had a poor prognosis after treatment with standard therapy and / or failed in one or more lines of previous therapy. In some embodiments, the subject has been treated or previously received at least or about at least or about 1, 2, 3 or 4 other therapies for the treatment of NHL that is not a lymphodeplective therapy and / or the dose of cells that express the antigen receptor. In some modalities, the individual has previously been treated with chemotherapy or radiation therapy. In some aspects, the individual is refractory or unresponsive to another therapy or therapeutic agent. In some modalities, the individual has a persistent or recurrent disease, for example, after treatment with another therapy or therapeutic intervention, including chemotherapy or radiation.
[00222] [00222] In some modalities, the individual is eligible for a transplant, as he is eligible for a hematopoietic stem cell transplant (HSCT), for example, allogeneic HSCT. In some such embodiments, the individual has not yet received a transplant, despite being eligible, prior to administration of the modified cells (e.g., RAQ-T cells) or a composition containing the cells to the individual, as provided herein.
[00223] [00223] In some modalities, the individual is one who is not eligible for a transplant, as he is not eligible for a hematopoietic stem cell transplant (HSCT), for example, allogeneic HSCT. In some embodiments, such an individual is administered to the modified cells (for example, RAQ-T cells) or a composition containing the cells according to the modalities provided here.
[00224] [00224] In some embodiments, the methods include administering cells to an individual selected or identified as having high-risk NHL. In some modalities, the individual exhibits one or more cytogenetic abnormalities, such as those associated with high-risk NHL. In some modalities, the individual is selected or identified based on a disease or condition characterized or determined as aggressive NHL, diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP), large B cell lymphoma rich in Trihistocyte cells (LCBRCTH), Burkitt's lymphoma, lining cell lymphoma (CSF) and / or follicular lymphoma (LF). In particular modalities, the individual to be treated using the methods provided here includes individuals with aggressive NHL, in particular, with diffuse large B cell lymphoma (LDGCB), not otherwise specified (NOS; again and transformed from indolent), primary mediatinal B-cell lymphoma (LCBMP) or grade 3B follicular lymphoma (LF3B). In some modalities, the individual has a poor performance status. In some respects, the population to be treated includes individuals with an Eastern Cooperative Oncology Group Performance Status (ECOG) ranging from 0 to 2. In other aspects of any of the modalities, the individuals to be treated included ECOG 0-1 or not include individuals with ECOG 2. In some aspects of any of the modalities, the individuals to be treated have failed two or more previous therapies. In some modalities, the individual does not have LDGCB transformed from marginal zone lymphoma (LZM) and chronic lymphocytic leukemia (LLC; Richter). In some modalities, an individual with CLL may exhibit Richter syndrome (RS), defined as the transformation of CLL into aggressive lymphoma, most commonly diffuse large B-cell lymphoma (LDGCB) (see, for example, Parikh et a Blood 2014 123: 1647-1657). In some modalities, the individual has lining cell lymphoma (CSF). In some modalities, the individual has characteristics that correlate with poor overall survival. In some modalities, the individual never achieved a complete response (CR), never received autologous stem cell transplantation (TACT), refractory to 1 or more second-line therapies, has primary refractory disease and / or has an ECOG performance score of 2.
[00225] [00225] In some embodiments, the individual to be treated includes a group of individuals with diffuse large B cell lymphoma (LDGCB), de novo or transformed from indolent lymphoma (NOS), primary mediastinal large B cell lymphoma (LCBMP), and grade 3b follicular lymphoma (LF3B) after failure of 2 therapy lines and ECOG score of 0-2, and the individual may optionally have previously been treated with allogeneic stem cell transplantation (SCT). In some embodiments, this group of individuals may be referred to as the "complete cohort". In some modalities, the individual is selected for treatment with adoptive cell therapy, if the individual meets these criteria. In some modalities, within that group ("total cohort"), the individual is not selected for treatment or excluded from treatment, if the individual has a poor performance status (for example, ECOG 2) and / or the LDGCB has been transformed from marginal zone lymphomas (LZM) and chronic lymphocytic leukemia (LLC, Richter). Thus, in some modalities, the individual is selected for treatment if the individual has individuals with diffuse large B cell lymphoma (LDGCB), de novo or transformed from indolent lymphoma (NOS), primary mediastinal large B cell lymphoma (LCBMP), and follicular lymphoma grade 3b (LF3B) after failure of 2 therapy lines and ECOG score of 0 or 1, and the individual may optionally have been previously treated with allogeneic stem cell transplantation (SCT), but does not have transformed LDGCB of zone lymphomas marginal (LZM) and chronic lymphocytic leukemia (LLC, Richter). In some modalities, this group of individuals can be referred to as the "main cohort". In some modalities, the individual to be treated are individuals in the "main cohort".
[00226] [00226] In some respects, the modalities provided are based on observations that a given population of individuals, for example, individuals in the "main cohort" who have been given a certain dose of cell therapy, shows a global response rate (TRG ) greater than 80%, with a complete response rate (CR) greater than 55%, with high durability, for example, a response that is maintained for a long period of time, for example, more than 3 months, with a TRG of 3 months over 65% and a three month CR rate of approximately 50%. In particular, the observations provided indicated that the three-month GTR was high in individuals with two or three chromosomal translocations ("double-hit" or "triple-hit" lymphoma); having MYC / 8g924 translocations locus, usually in combination with the t (14; 18) (932; 921) bcl-2 or / and BCL6 / 3927 chromosomal translocation; see, for example, Xu et al. (2013) Int J Clin Exp Pathol. 6 (4): 788—794),
[00227] [00227] In some aspects, compositions, methods and uses are provided for the administration of a defined composition of cell therapy, in particular doses, which are associated with a high response rate and / or high response durability, and low levels and / or incidence of toxicity. In some embodiments, the composition or dose administered is a flat and / or fixed dose, such as a precise flat dose, of cells and / or one or more cells with a particular phenotype, such as a particular number of these cells or a number that is within a particular range and / or degree of variability or variation compared to a target number. In some embodiments, the administered composition or dose contains a defined ratio of CD4 * and CD8 * cells (for example, 1: 1 ratio of CD4 * T cells: CD8 * RAQ *) and / or contains a ratio that is within a a certain degree of variability in such a relationship, such as not more than + 10%, as not more than + 8%, as a degree of variability or variance of not more than + 10%, as not more than + 8%. In some embodiments, CD4 * and CD8 * cells are formulated and administered individually. In some embodiments, the administered cells exhibit consistent activity and / or function, for example, cytokine production, apoptosis and / or expansion. In some embodiments, the compositions provided exhibit highly consistent and defined activity and low variability between cells, for example, in terms of cell number, cell function and / or cell activity, in the composition or between preparations. In some modalities, consistency in activity and / or function, for example, low variability between preparations of compositions, allows for better efficiency and / or safety. In some embodiments, administration of the defined compositions resulted in low product variability and low toxicity, for example, SLC or neurotoxicity, compared to administration of highly heterogeneous cell compositions. In some embodiments, the consistent, defined composition also exhibits consistent cell expansion. Such consistency can facilitate the identification of the dose, therapeutic window, assessment of the dose response and identification of factors of the individual that may correlate with the safety or toxicity results.
[00228] [00228] In some modalities, in a certain cohort of individuals who receive a single infusion at a particular dose level, a durable response rate after 6 months of more than 60% can be achieved. In some modalities, individuals in some cohorts may achieve an overall response rate (TRG, in some cases also known as an objective response rate) greater than 80%, a complete response rate (CR) greater than 60% and / or a high rate of CR lasting 6 months. In some modalities, individuals who receive a defined dose show better safety results, for example, more than two-thirds of individuals who do not exhibit any SLC or NT. In some respects, the rate of severe SLC or severe NT is low. In some modalities, a higher exposure (for example, Cmax and AUC0o-28) observed with a particular defined dose, is not associated with increased toxicity, for example, SLC or NT. In some modalities, particular factors of the individual, for example, certain biomarkers, can be used to predict the risk of toxicity. In some modalities, the modalities provided can be used to achieve a high response rate with a low risk of toxicity.
[00229] [00229] In some modalities, no more than 25%, no more than 20%, no more than 15%, no more than 10% or no more than
[00230] [00230] In some modalities, the modalities provided provide an advantage, for example, allows the administration of cell therapy on an outpatient basis. In some modalities, the administration of cell therapy, for example, the dose of T cells according to the modalities provided, can be performed on an outpatient basis or does not require admission of the patient to the hospital, such as admission to the hospital that requires an overnight stay. In some modalities, such outpatient administration may allow increased access and reduced costs, while maintaining a high and durable response rate with low toxicity. In some respects, outpatient treatment can be advantageous for patients who are already otherwise immunocompromised by previous treatments, for example, post-lymphodepletion and are at increased risk of exposure in a hospital stay or in a hospital setting. In some respects, outpatient treatments also increase treatment options for individuals who may not have access to inpatients, hospital settings or transplant centers, thereby expanding access to treatment. In some modalities, individuals treated on an outpatient basis using the compositions, articles of manufacture, kits, methods and uses provided remain in outpatient facilities for at least 3 days or a certain percentage of individuals, for example, at least 60%, at least 70%, at least least 80%, at least 85%, at least 90% or at least 95%
[00231] [00231] In some modalities, the methods, cells and compositions can provide high rate of durable response to individuals across a range of patient characteristics and / or tumor burden. In some modalities, the methods, cells and compositions can provide a high rate of durable response to high-risk patients with poor prognosis, with a reduced risk of adverse effects or toxicities. In some embodiments, the methods and uses provide or achieve a higher response rate and / or more durable responses or efficacy and / or a reduced risk of toxicity or other side effects that may be associated with cell therapy, such as neurotoxicity (NT ) or cytokine release syndrome (SLC). In some respects, the observations provided indicated a low rate of severe NT (NTg) or severe SLC (SLCg) and a high rate of patients with no toxicity, for example, NT or SLC.
[00232] [00232] In some modalities, at least 35%, at least 40%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70% or at least 75% or more of individuals treated in accordance with the methods provided and / or with the articles of manufacture or compositions provided, reached a complete response (RC). In some embodiments, at least 50%, at least 60%, at least 70%, at least 80% or at least 90% of the individuals treated according to the methods provided and / or the articles of manufacture or compositions provided, reach an objective answer (RO). In some embodiments, at least 60%, at least 70%, at least 80%, at least 90%, at least 95% or more of the individuals treated according to the methods provided and / or the articles of manufacture or compositions provided , reach an RC or RO for a month, for two months or for three months.
[00233] [00233] In some modalities, for three months, four months, five months, six months or more after the beginning of the administration of cell therapy, at least 60%, at least 70%, at least 80%, at least 90%, at least 95% or more of the individuals treated according to the methods provided and / or the articles of manufacture or compositions provided remain in response, just as they remain in RC or OR. In some modalities, such a response, such as RC or RO, is durable for at least three months, four months, five months, six months, seven months, eight months or nine months, as well as at least or about 60% , at least 70%, at least 80%, at least 90%, at least 95% or more of the individuals treated according to the methods provided or in such individuals who achieve CR for a month or three months. In some embodiments, at least 60%, at least 70%, at least 80%, at least 90%, at least 95% or more of the individuals treated according to the methods provided and / or the articles of manufacture or compositions provided , or such individuals who achieve CR for a month or three months, survive or survive without progression for more than or more than about three months, four months, five months, six months, seven months, eight
[00234] [00234] In some embodiments, the resulting response observed in such individuals by treatment according to the methods provided and / or the articles of manufacture or compositions provided, is associated with or results in a low risk of any toxicity or low risk of serious toxicity in most treated individuals. In some embodiments, more than or more than about 30%, 35%, 40%, 50%, 55%, 60% or more of the individuals treated according to the methods provided and / or the articles of manufacture or compositions provided do not exhibit any degree of SLC or any degree of neurotoxicity (NT). In some embodiments, more than or more than about 50%, 60%, 70%, 80% or more of the individuals treated according to the methods provided and / or the articles of manufacture or compositions provided do not exhibit severe SLC or grade SLC 3 or higher. In some modalities, more than or more than about 50%, 60%, 70%, 80% or more of the individuals treated according to the methods provided and / or the articles of manufacture or compositions provided, do not exhibit severe neurotoxicity or neurotoxicity grade 3 or higher, such as grade 4 or 5 neurotoxicity.
[00235] [00235] In some modalities, at least or about 45%, 50%, 60%, 65%, 70%, 75%, 80%, 85%, 90% or 95% of the individuals treated according to the method and / or with the articles of manufacture or compositions provided do not exhibit early onset SLC or neurotoxicity and / or do not onset of SLC before 1 day, 2 days, 3 days or 4 days after the start of administration. In some modalities, at least or about 45%, 50%, 60%, 65%, TO%, 75%, 80%, 85%, 90% or 95% of the individuals treated according to the methods and / or with the articles of manufacture or compositions provided, do not exhibit neurotoxicity before 3 days,
[00236] [00236] In some embodiments, such results are seen after administration of or about 5 x 10 7 to 1.5 x 10 8, such as 5 x 10 7 to 1 x 10 th total recombinant receptor expression T cells, such as a dose of T cells including CD4 * and CD8 * T cells administered in a defined ratio as described herein, for example, at or about a 1: 1 ratio and / or in an accurate or flat or fixed number of RAQ * T cells , or precise or flat or fixed number of a specific type of RAQ * T cells, such as CD4 * RAQ '* cells and / or CD8 * RAQ * cells and / or a number of any such cells that are within a specified degree of variation, such as no more than, + or - (more or less, in some cases indicated as +), 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15% in compared to that precise or flat or fixed number. In some embodiments, such a flat or fixed number of cells is at or about 2.5 x 107, 5 x 107, x 107, 15 x 107 or 20 x 107, for example, total RAQ * T cells or CD8 * and / or CD4 * RAQ * T cells. In some embodiments, the number of cells in the dose includes or essentially consists of 5 x 107 CD4 * RAQ * cells (optionally 2.5 x 107 CD4 * RAQ cells * and 2.5 x 107 CD8 * RAQ cells *) ; in some embodiments, it essentially includes or consists of 10 x 107 T cells RAQ * (optionally 5 x 107 T cells CD4 * RAQ * and 5 x 107 T cells CD8 * RAQ *). In some respects, the number of cells administered is within a certain degree of variation of such numbers in the aforementioned modalities, such as within more or less (+) 5, 6, 7, 8, 9 or 10%, as within more or less 8%, compared to such number (s) of cells. In some respects, the dose is within a range in which a correlation is observed (optionally a linear relationship) between the number of such cells (for example, total RAQ * T cells or CD8 * and / or CD4 * cells) RAQ *) and one or more results indicative of therapeutic response, or duration of the same (for example, the probability of achieving a remission, a complete remission and / or a particular duration of remission) and / or the duration of any of the above . In some respects, it has been found that the higher dose of administered cells can result in a greater response without or without substantially impacting or affecting the incidence or risk of toxicity (eg, SLC or neurotoxicity), or the degree of incidence or risk of toxicity in the individual, for example, severe SLC or severe neurotoxicity.
[00237] [00237] In some respects, the methods provided may achieve a high or particular response rate (such as a response rate among a population assessed after a certain post-administration period, such as three months or six months), for example, TRG (such as a 6-month or 3-month TRG) of 40% or more, 45% or more, 50% or more, 55% or more, 60% or more, 65% or more, 70% or more, 75 %, 80% or 81%, 82%, 83%, 84% or 85% or more and CR rate (such as a 6 month or 3 month CR rate) of 30% or more, 35% or more, 40% or more, 45% or more, 50% or more, 55% or more, 60% or more, 65% or more, 70% or more, 71%, 72%, 73% or more or approximately 75% or more, which is also durable, such as for a particular period of time or at least a particular period of time, for example, is extended by more than 1, 3 or 6 months or more or 9 months or more after the start of therapy. In some modalities, such response and durability rates are received after only a single administration or dose of such therapy. The treatment of such individuals by the methods provided and / or with the articles of manufacture or compositions provided, in some modalities, also results in individuals who achieve a high response rate, not yet exhibiting a higher incidence of developing toxicity, such as neurotoxicity or SLC, even at higher doses of the cells. In some modalities, about or more than 50%, 55% or 60% of individuals who achieve such responses do not develop any degree of toxicity, such as any degree of SLC and / or neurotoxicity.
[00238] [00238] Thus, in some modalities, the methods, articles of manufacture and / or compositions provided, may offer advantages over other methods or solutions or approaches available for treatment, such as for adoptive cell therapy. In particular, among the modalities provided, are those that offer an advantage to individuals with high-risk NHL, achieving a durable response at a high rate, with reduced incidence of toxicities or side effects. A. Method of treatment
[00239] [00239] Treatment methods involving administration of modified cells or compositions containing modified cells, such as modified T cells, are provided herein. Also provided are methods and uses of modified cells (e.g., T cells) and / or compositions thereof, including methods for treating individuals with a disease or condition such as leukemia or lymphoma, for example, non-Hodgkin's lymphoma (NHL), which involves the administration of the modified cells and / or their compositions. In some embodiments, the methods and uses provided may achieve improved response and / or more durable responses or efficacy and / or a reduced risk of toxicity or other side effects, for example, in specific groups of treated individuals, compared to certain alternative methods . In some aspects, methods of administering modified cells or compositions containing modified cells, such as modified T cells, are also provided to an individual, such as an individual who has a disease or disorder. In some aspects, uses of modified cells or compositions containing modified cells are also provided, such as modified T cells for treating a disease or disorder. In some aspects, uses of modified cells or compositions containing modified cells are also provided, such as modified T cells for the manufacture of a medicament for the treatment of a disease or disorder. In some aspects, methods of administering modified cells or compositions containing modified cells, such as modified T cells, are also provided for use in treating a disease or disorder, or for administration to an individual having a disease or disorder. In some respects, the uses of the modified cells or compositions containing modified cells, such as modified T cells, are in accordance with any of the methods described herein.
[00240] [00240] General methods for administering cells for adoptive cell therapy are known and can be used in connection with the methods and compositions provided. For example, methods of adoptive T cell therapy are described, for example, in US Patent Application Publication No. 2003/0170238 by Gruenberg et al; US Patent No. 4,690,915 to Rosenberg; Rosenberg (2011) Nat Rev Clin Oncol. 8 (10): 577-85). See, for example, Themeli et al.
[00241] [00241] The disease or condition that is treated can be any one in which the expression of an antigen is associated with and / or involved in the etiology of a disease condition or disorder, for example, cause, exacerbation or otherwise is involved in such a disease, condition or disorder. Exemplary diseases and conditions can include diseases or conditions associated with malignancy or cell transformation (for example, cancer), autoimmune or inflammatory disease or an infectious disease, for example, caused by a bacterial, viral or other pathogen. Exemplary antigens, which include antigens associated with various diseases and conditions that can be treated, are described above. In particular embodiments, the chimeric antigen receptor or transgenic RCT binds specifically to an antigen associated with the disease or condition.
[00242] [00242] Among the diseases, conditions and disorders are tumors, including solid tumors, hematological malignancies and melanomas, and including localized and metastatic tumors, infectious diseases, such as infection by a virus or other pathogen, for example, HIV, HCV, HBV , CMV, HPV and parasitic disease and autoimmune and inflammatory diseases. In some embodiments, the disease, disorder, or condition is a tumor, cancer, malignancy, neoplasm, or other disease or proliferative disorder. Such diseases include, but are not limited to, leukemia, lymphoma, for example, acute myeloid (or myelogenous) leukemia (AML), chronic (or myelogenous) myeloid leukemia (CML), acute lymphocytic (or lymphoblastic) leukemia (ALL) , chronic lymphocytic leukemia (LLC), hairy cell leukemia (PCL), small lymphocytic lymphoma (LLP), lining cell lymphoma (CSF), marginal zone lymphoma, Burkitt's lymphoma, Hodgkin's lymphoma (LH),
[00243] [00243] In some modalities, the NHL can be represented based on the Lugano classification (see, for example, Cheson et al., (2014) JCO 32 (27): 3059-3067; Cheson, BD (2015) Chin Clin Oncol 4 (1): 5). In some cases, the stages are described by the Roman numerals | to IV (1-4), and limited-stage lymphomas (| or | l) that affect an organ outside the lymphatic system (an extranodal organ) are indicated by an E. Stage | represents involvement in a node or a group of adjacent nodes or a single extranodal lesion without nodal involvement (IE). Stage 2 represents involvement in two or more nodal groups on the same side of the diaphragm or stage | or Il by nodal extension with limited contiguous extranodal involvement (IIE). Stage ll represents involvement in the nodes on either side of the diaphragm or in the nodes above the diaphragm with involvement of the spleen. Stage IV represents involvement in extra non-contiguous extralymphatic involvement. In addition, "bulky disease" can be used to describe large tumors in the chest, particularly in stage Il. The extent of the disease is determined by positron emission tomography (PET) - computed tomography (CT) for avid lymphomas and CT for non-avid histologies.
[00244] [00244] In some modalities, the Eastern Cooperative Oncology Group (ECOG) development status indicator can be used to assess or select individuals for treatment, for example, individuals who have performed poorly on previous therapies (see, for example, Oken et al. (1982) Am J Clin Oncol. 5: 649-655). The ECOG Performance Status Scale describes a patient's level of functioning in terms of his ability to take care of himself, daily activity and physical capacity (for example, walking, working, etc.). In some embodiments, an ECOG performance status of 0 indicates that an individual can perform normal activity. In some aspects, individuals with an ECOG performance status of 1 exhibit some restriction in physical activity, however, the individual is totally outpatient. In some respects, patients with an ECOG performance status of 2 are more than 50% outpatient. In some cases, the individual with an ECOG performance status of 2 may also be able to take care of themselves; see, for example, Sorensen et al., (1993) Br J Cancer 67 (4) 773-775. The criteria that reflect the state of ECOG performance are described in Table 1 below: [00 CDE performance status o Fully active, capable of performing all pre- | 1 Restricted to physically strenuous activity, however, outpatient and capable of carrying out work of a light or sedentary nature, | attentive
[00245] [00245] In some modalities, the individual has or has been identified as having a doubleftriple hit lymphoma or a lymphoma of the doubleftriple hit molecular subtypes In some modalities, the lymphoma is a double-hit lymphoma characterized by the presence of MYC (oncogene myelocytomatosis) ), BCL2 (B 2 cell lymphoma) and / or BCL6 gene rearrangements (B 6 cell lymphoma) (eg translocations). In some embodiments, gene rearrangement affects the MYC / 8924 locus in combination with another gene rearrangement. For example, the other gene rearrangement includes t (14; 18) (932, 921) involving BCL2. In some embodiments, gene rearrangements affect the MYC / 8924 locus in combination with BCL6 / 3927. In some modalities, lymphoma is a triple hit lymphoma characterized by the presence of MYC, BCL2 and BCL6 gene rearrangements; see, for example, Aukema et al., (2011) Blood 117: 2319-2331. In some aspects of such modalities, the individual is ECOG 0-1 or has or is not suspected or characterized as having LDGCB transformed from LZM or LLC. In aspects, therapy is indicated for such individuals and / or the instructions indicate administration to an individual within such a population. In some modalities, based on the 2016 WHO criteria (Swerdlow et al., (2016) Blood 127 (20): 2375-2390), double / triple hit lymphoma can be considered high-grade B-cell lymphoma, with MYC and BCL2 and / or BCL6 rearrangements with LDGCB histology (doublevtriple hit).
[00246] [00246] In some embodiments, the disease or condition is an infectious disease or condition, such as, but not limited to, viral, retroviral, bacterial and protozoal infections, immunodeficiency, Cytomegalovirus (CMV), Epstein-Barr virus (EBV) , adenovirus, polyomavirus BK. In some embodiments, the disease or condition is an autoimmune or inflammatory disease or condition, such as arthritis, for example, rheumatoid arthritis (RA), Type 1 diabetes, systemic lupus erythematosus (SLE), inflammatory bowel disease, psoriasis, scleroderma, disease autoimmune thyroid, Grave's disease, Crohn's disease, multiple sclerosis, asthma and / or a disease or condition associated with transplantation.
[00247] [00247] In some modalities, the antigen associated with the disease or disorder is selected from the integrin avB6 (integrin avb6), B cell maturation antigen (BCMA), B7-H3, B7-H6, carbonic anhydrase 9 (CA9, also known as CAIX or G250), a testicular cancer antigen, cancer / testicle 1B antigen (CTAG, also known as NY-ESO-1 and LAGE-2), carcinoembryonic antigen (CEA), a cyclin, A2 cyclone, Ligand 1 Motif CC (CCL-1), CD19, CD20, CD22, CD23, CD24, CD30, CD33, CD38, CD44, CD44v6, CD44v7 / 8, CD123, CD133, CD138, CD171, chondroitin sulfate proteoglycan 4 (CSPG4), epidermal growth factor protein (EGFR), mutation of type II epidermal growth factor receptor (EGFR vIll), epithelial glycoprotein 2 (EPG-2), epithelial glycoprotein 40 (EPG-40), ephrinB2 , ephrin A2 receptor (EPHa2), estrogen receptor, type 5 Fc receptor (FCRL5; also known as homologous Fc receptor 5 or FCRHB5), d receptor and fetal acetylcholine (AchR fetal), a folate-binding protein (FBP), alpha folate receptor, GD2 ganglioside, O-acetylated GD2 (GD20), GD3 ganglioside, glycoprotein 100 (gp100), glypican-3 (GPC3), Receiver Coupled to
[00248] [00248] In some embodiments, the antigen is or includes an antigen specific to the pathogen or expressed to the pathogen. In some embodiments, the antigen is a viral antigen (such as a viral antigen from HIV, HCV, HBV, etc.), bacterial antigens and / or parasitic antigens.
[00249] [00249] In some modalities, cell therapy, for example, adoptive T cell therapy, is performed by autologous transfer, in which cells are isolated and / or otherwise prepared from the individual who should receive the cell therapy or of a sample derived from such an individual. Thus, in some aspects, the cells are derived from an individual, for example, a patient in need of treatment and the cells, after isolation and processing, are administered to the same individual.
[00250] [00250] In some modalities, cell therapy, for example, adoptive T cell therapy, is carried out by allogeneic transfer, in which cells are isolated and / or otherwise prepared from an individual other than an individual who must receive or finally receive cell therapy, for example, a first individual. In such embodiments, the cells are then administered to a different individual, for example, a second individual, of the same species. In some embodiments, the first and second individuals are genetically identical. In some embodiments, the first and second individuals are genetically similar. In some embodiments, the second individual expresses the same HLA class or supertype as the first individual.
[00251] [00251] The cells can be administered by any suitable means, for example, by bolus infusion, by injection, for example, intravenous or subcutaneous injections, intraocular injection, periocular injection, subretinal injection, intravitreal injection, trans-septal injection, injection subscleral injection, intracoroidal injection, intracameral injection, subconjectival injection, subconjunctival injection, sub-Tenon injection, retrobulbar injection, peribulbar injection or posterior juxescleral release In some modalities, they are administered by parenteral, intrapulmonary and intranasal administration and, if desired for local treatment , intralesional administration. Parenteral infusions include intramuscular, intravenous, intraarterial, intraperitoneal or subcutaneous administration. In some embodiments, a given dose is administered by a single bolus administration of the cells. In some embodiments, it is administered by multiple bolus administrations of the cells, for example, over a period of no more than 3 days, or by administration of continuous infusion of the cells. In some modalities, the administration of the cell dose or any additional therapies, for example, lymphodeplective therapy, intervention therapy and / or combination therapy, is performed via outpatient delivery.
[00252] [00252] For disease prevention or treatment, the appropriate dosage may depend on the type of disease to be treated, the type of recombinant cells or receptors, the severity and course of the disease, whether the cells are administered for the purposes of prevention or treatment, previous therapy, clinical history and individual response to cells and at the discretion of the attending physician. The compositions and cells are, in some embodiments, properly administered to the individual at the same time or over a series of treatments.
[00253] [00253] In some embodiments, cells are administered as part of a combined treatment, such as simultaneously or sequentially with, in any order, another or additional therapeutic intervention, such as an antibody or modified cell or receptor or agent, such as a cytotoxic or therapeutic agent. The cells in some modalities are co-administered with one or more additional therapeutic agents or in connection with another therapeutic intervention, simultaneously or sequentially in any order. In some embodiments, the additional therapeutic agent is any intervention or agent described here, such as any interventions or agents described, that can ameliorate the symptoms of toxicity described herein, for example, in Section Il. In some contexts, cells are co-administered with another therapy sufficiently close in time, so that cell populations enhance the effect of one or more additional therapeutic agents, or vice versa. In some embodiments, the cells are administered before one or more additional therapeutic agents. In some embodiments, the cells are administered after one or more additional therapeutic agents. In some embodiments, the one or more additional agents include a cytokine, such as IL-2, for example, to enhance persistence. In some modalities, the methods - comprise the administration of a chemotherapeutic agent.
[00254] [00254] In some embodiments, the methods comprise the administration of a chemotherapeutic agent, for example, a conditioning chemotherapeutic agent, for example, to reduce the tumor burden before administration.
[00255] [00255] The preconditioning of individuals with immunodepleting therapies (for example, lymphodepleting) in some aspects may improve the effects of adoptive cell therapy (ACT).
[00256] [00256] Thus, in some embodiments, the methods include administering a preconditioning agent, such as a chemotherapeutic agent or lymphodeplector, such as cyclophosphamide, fludarabine or combinations thereof, to an individual prior to the initiation of cell therapy, For example , the individual can be administered with a preconditioning agent at least 2 days before, such as at least 3, 4, 5, 6 or 7 days prior to the start of cell therapy. In some embodiments, the individual is administered with a preconditioning agent no more than 7 days before, such as no more than 6, 5, 4, 3 or 2 days before, at the beginning of cell therapy.
[00257] [00257] In some embodiments, the individual is preconditioned with cyclophosphamide at a dose between or between about 20 mg / kg and 100 mg / kg, such as between or between about 40 mg / kg and 80 mg / kg. In some aspects, the individual is preconditioned with or with approximately 60 mg / kg of cyclophosphamide. In some embodiments, cyclophosphamide can be administered in a single dose or in a plurality of doses, such as those administered daily, every two days or every three days. In some embodiments, cyclophosphamide is administered once daily for one or two days. In some modalities, where the lymphodeplective agent comprises cyclophosphamide, does the individual receive cyclophosphamide at a dose between or between about 100 mg / m and 500 mg / m , such as between or between about 200 mg / m and 400 mg / m , or 250 mg / m and 350 mg / m , inclusive. In some cases, is the individual given about 300 mg / m cyclophosphamide. In some embodiments, cyclophosphamide can be administered in a single dose or in a plurality of doses, such as those administered daily, every two days or every three days. In some embodiments, cyclophosphamide is administered daily, such as for 1 - 5 days, for example, for 3 to 5 days. In some cases, is the individual given about 300 mg / m cyclophosphamide, daily for 3 days, before the start of cell therapy.
[00258] [00258] In some modalities, where the lymphodeplective agent comprises fludarabine, is the individual administered with fludarabine in a dose between or between about 1 mg / m and 100 mg / m , such as between or between about 10 mg / m and 75 mg / m , 15 mg / m and 50 mg / mº, mg / m and 40 mg / m , or 24 mg / m and 35 mg / m , inclusive. In some cases, is the individual given about 30 mg / m of fludarabine. In some embodiments, fludarabine can be administered in a single dose or in a plurality of doses, such as those administered daily, every two days or every three days. In some embodiments, fludarabine is administered daily, such as for 1 - 5 days, for example, for 3 to 5 days. In some cases, is the individual given about 30 mg / m of fludarabine, daily for 3 days, before the start of cell therapy.
[00259] [00259] In some embodiments, the lymphodeplective agent comprises a combination of agents, such as a combination of cyclophosphamide and fludarabine. Thus, the combination of agents can include cyclophosphamide at any dose or schedule of administration, such as those described above, and fludarabine at any dose or schedule of administration, such as those described above. For example, in some ways, the individual is administered 60 mg / kg (- 2 g / m ) Of cyclophosphamide and 3 to 5 doses of 25 mg / m fludarabine before the first or subsequent dose.
[00260] [00260] After the administration of the cells, the biological activity of the cell populations modified in some modalities is measured, for example, by any of several known methods. The parameters to be assessed include the specific binding of a modified or natural T cell or another cell immune to the antigen, in vivo, for example, by image or ex vivo, for example, by ELISA or flow cytometry. In certain embodiments, the ability of the modified cells to destroy target cells can be measured using any suitable known methods, such as cytotoxicity assays described in, for example, Kochenderfer et al., J. Immunotherapy, 32 (7): 689-702 (2009) and Herman et al JJ. Immunological Methods, 285 (1): 25-40 (2004). In certain embodiments, the biological activity of cells is measured by testing the expression and / or secretion of one or more cytokines, such as CD107a, IFNy, IL-2 and TNF. In some aspects, biological activity is measured by assessing the clinical outcome, such as reduction in tumor burden or burden.
[00261] [00261] In certain modalities, the modified cells are further modified in several ways, so that their therapeutic or prophylactic efficacy is increased. For example, the modified RAQ or RCT expressed by the population can be conjugated directly or indirectly through a linker to a targeting fraction. The practice of conjugating compounds, for example, the RAQ or RCT, for targeting portions is known. See, for example, Wadwa et al., J. Drug Targeting 3: 1111 (1995) and U.S. Patent 5,087,616. In some embodiments, the cells are administered as part of a combined treatment, such as simultaneously or sequentially with, in any order, another therapeutic intervention, such as an antibody or modified cell or receptor or agent, such as a cytotoxic or therapeutic agent. The cells in some modalities are co-administered with one or more additional therapeutic agents or in connection with another therapeutic intervention, simultaneously or sequentially in any order. In some contexts, cells are co-administered with another therapy sufficiently close in time, so that cell populations enhance the effect of one or more additional therapeutic agents, or vice versa.
[00262] [00262] In some embodiments, a dose of cells is administered to individuals according to the methods provided and / or the articles of manufacture or compositions provided. In some modalities, the size or timing of doses is determined by the specific disease or condition in the individual. In some cases, the size or timing of doses for a particular disease, in view of the description provided, can be determined empirically.
[00263] [00263] In some embodiments, the cell dose comprises between or at about 2 x 10º of cells / kg and at or at about 2 x 10º of cells / kg, such as between or at or about 4 x 10º of cells / kg and at or about 1 x 10º of cells / kg or between or or about and 6 x 10º of cells / kg and at or about 8 x 10º of cells / kg. In some embodiments, the cell dose comprises no more than 2 x 10º of the cells (for example, expressing antigens, such as RAQ expression cells) per kilogram of the individual's body weight (cells / kg), as well as no more than or at or about 3 x 105º cells / kg, no more than or at or about 4 x 10º cells / kg, no more than or at or about 5 x 10º cells / kg, no more than at or at about 6 x 10 th cells / kg, no more than at or at about 7 x 10 th cells / kg, no more than at or at about 8 or 10 cells / kg, no more than or at about 9 x 10 th cells / Kkg, or no more than or about 1 x 10 th cells / kg, or no more than or at about 2 x
[00264] [00264] In certain embodiments, the cells, or individual populations of cell subtypes, are administered to the individual in a range of about one million to about 100 billion cells and / or this amount of cells per kilogram of body weight, such as, for example, 1 million to about 50 billion cells (for example, about 5 million cells, about 25 million cells, about 500 million cells, about 1 billion cells, about 5 billion cells, about 20 billion cells, about billions of cells, about 40 billion cells, or a range defined by two of the previous values), like about 10 to 100 billion cells (for example, about 20 million cells, about 30 million cells, about 40 million cells, about 60 million cells, about 70 million cells, about 80 million cells, about 90 million cells, about 10 billion cells, about 25 billion cells, about 50 billion million cells, about 75 billion cells, about 90 billion cells or a range defined by two previous values) and, in some cases, about 100 million cells to about 50 billion cells (for example, about of 120 million cells, about 250 million cells, about 350 million cells, about 450 million cells, about 650 million cells, about 800 million cells, about 900 million cells, about 3 billion cells, about 30 billion cells, about 45 billion cells) or any value between these ranges and / or per kilogram of body weight. Dosages may vary depending on the particular attributes of the disease or disorder and / or patient and / or other treatments.
[00265] [00265] In some embodiments, the cell dose is a flat dose of cells or fixed dose of cells, so that the cell dose is not linked or based on the body surface area or an individual's weight.
[00266] [00266] In some embodiments, the dose of genetically modified cells comprises from or about 1 x 10 th to 5 x 10 th total RAQ expression T cells, 1 x 10 th to 2.5 x 10 th total RAQ expression T cells , 1 x 10 th to 1 x 10 th total RAQ expression T cells, 1 x 10 th to 5 x 107 total RAQ expression T cells, 1 x 10 th to 2.5 x 107 total RAQ expression T cells, 1 x 10 th to 1 x 107 total RAQ expression T cells, 1 x 10 th to 5 x 10 th total RAQ expression T cells, 1 x 10 th to 2.5 x 10 th total RAQ expression T cells, 1 x 10 th to 1 x 106 total RAQ expression T cells, 1 x 10 th to 5 x 10 th total RAQ expression T cells, 1 x 106 th to 2.5 x 10 th total RAQ expression T cells, 1 x 10 th to 1 x 108 T cells total RAQ expression cells, 1 x 10º to 5 x 107 total RAQ expression T cells, 1 x 10º to 2.5 x 107 total RAQ expression T cells, 1 x 106º to 1 x 107 T cells of total RAQ expression
[00267] [00267] In some embodiments, the dose of genetically modified cells comprises at least or at least about 1 x 105 RAQ expression cells, at least or at least about 2.5 x 10º RAQ expression cells, at least or at least about 5 x 105º RAQ expression cells, at least or at least about 1 x 10º RAQ expression cells, at least or at least about 2.5 x 10º RAQ expression cells, at least or at least about 5 x 10 10 RAQ expression cells, at least or at least about 1 x 10 7 RAQ expression cells, at least or at least about 2.5 x 107 RAQ expression cells, at least or at least about 5 x 107 RAQ expression cells, at least or at least about 1 x 10º RAQ expression cells, at least or at least about 2.5 x 10º RAQ expression cells, or at least less or at least about 5 x 10º RAQ expression cells.
[00268] [00268] In some embodiments, cell therapy comprises the administration of a dose comprising a number of cells from or from about 1 x 10 to 5 x 10 10 cells of expression of total recombinant receptors, total T cells or peripheral blood mononuclear cells total cells (PBMC), from or from about 5 x 10 to 1 x 107 total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMC) or from or from about 1 x 10 to 1 x 107 total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMC), each inclusive. In some embodiments, cell therapy comprises administering a dose of cells comprising a number of cells of at least or at least about 1 x 10 th total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMCs) ), such as at least or at least 1 x 108, at least or at least about 1 x 107, at least or at least about 1 x 10 ° of those cells. In some embodiments, the number is with reference to the total number of CD3 * or CD8 *, in some cases also recombinant receptor expression cells (for example, RAQ ”). In some embodiments, cell therapy comprises administering a dose comprising a number of cells from or from about 1 x 10 th to 5 x 10 th total CD3 * or CD8 * T cells or CD3 * or CD8 * recombinant receptor expression cells , from or from about 5 x 10 to 1 x 107 total CD3 * or CD8 * T cells or CD3 * or CD8 * recombinant receptor expression cells or from or from about 1 x 10 to 1 x 107 T cells total CD3 * or CD8 * or CD3 * or CD8 * recombinant receptor expression cells, each inclusive. In some embodiments, cell therapy comprises administering a dose comprising a number of cells from either about 1 x 10 th to 5 x 10 th total CD3 * / RAQ * or CD8 * / RAQ * cells, or about 5 x 10 th to 1 x 107 total CD3 * / RAQ * or CD8 * / RAQ '* cells, or from or about 1 x 10 th to 1 x 107 total CD3 * / RAQ * or CD8 * / RAQ ”cells, each one inclusive.
[00269] [00269] In some embodiments, the dose of T cells comprises: a or about 5 x 10 ”recombinant receptor expression T cells or a or about 2.5 x 107 CD8 * T cells of recombinant receptor expression. In some embodiments, the T cell dose comprises: about 1 x 10 10 recombinant receptor expression T cells or about 5 x 10 7 CD8 * T cells for recombinant receptor expression. In some embodiments, the dose of T cells comprises: about 1.5 x 10 10 T cells of recombinant receptor expression or a or about 0.75 x 10 T CD8 * cells of recombinant receptor expression.
[00270] [00270] In some embodiments, dose T cells include CD4 * T cells, CD8 * T cells or CD4 * and CD8 * cells.
[00271] [00271] In some modalities, for example, where the individual is human, the CD8 * T cells in the dose, including in a dose including CD4 * and CD8 * T cells, include between about 1 x 10 th and 5 x 10 th total of recombinant receptor (eg, RAQ) expressing CDB8 * cells, for example, in the range of about 5 x 10 th to 1 x 10 th cells, such cells 1 x 107, 2.5 x 107, 5 x 107, 7.5 x 107, 1 x 10º or 5 x 10º in those total cells, or the range between two of the previous values. In some modalities, the patient receives multiple doses and each dose or the total dose can be within any of the previous values. In some embodiments, the dose of cells comprises the administration of or about 1 x 107 to 0.75 x 10 th CD8 * T cells of expression of total recombinant receptors, 1 x 10 th to 2.5 x 10 th CD8 * T cells of expression of total recombinant receptors, of or from about 1 x 107 to 0.75 x 10º CD8 * T cells of expression of total recombinant receptors, each inclusive. In some embodiments, the dose of cells comprises administration of about 1 x 107, 2.5 x 107, 5x 107 7.5 x 107, 1 x 108 or 5 x 10th CD8 * T cells of expression of total recombinant receptors.
[00272] [00272] In some embodiments, for example, where the individual is human, the dose includes less than about 2 x 10 th to 1 x 10 th total recombinant receptor expression cells (eg RAQ), T cells or mononuclear cells from peripheral blood (PBMC), for example, in the range of about 1 x 10º to 2x 10º or 1 x 10º to 1 x 10º cells, such as 2 x 106, 5 x 106, 1 x 107, 5 x 107, 1 x 10º or 1.5 x 10º of these total cells or the range between two of the previous values. In some modalities, where the individual is a human, the dose includes between about 1 x 10º and 3 x 108º total recombinant receptor expression cells (for example, RAQ), for example, in the range of about 1 x 107 to 2 x 10º of these cells, such as 1 x 107, 5x 107, 1 x 10º or 1.5 x 10º of these total cells, or the range between any two of the previous values. In some modalities, the patient receives multiple doses and each dose or the total dose can be within any of the previous values. In some embodiments, the cell dose comprises the administration of either about 1 x 10 th to 5 x 10 th total recombinant receptor expression T cells or total T cells, 1 x 10 th to 1.5 x 108 T cells expressing the recombinant receptor. total recombinant receptor or total T cells, 1 x 105 to 1 x 10 th total recombinant receptor expression T cells or total T cells, from or about 5 x 10 th to 1 x 107 total recombinant receptor expression T cells or cells Total T, or from or about 1 x 10 th to 1 x 107 total recombinant receptor expression T cells or total T cells, each inclusive.
[00273] [00273] In some embodiments, dose T cells include CD4 * T cells, CD8 * T cells or CD4 * and CD8 * T cells.
[00274] [00274] In some embodiments, for example, where the individual is human, the CD8 * T cells in the dose, including in a dose including CD4 * and CD8 * T cells, include between about 1 x 10 th and 1 x 10 th recombinant receptor total (for example, RAQ) expressing CD8 * cells, for example, in the range of about 5 x 10 th to 1 x 10 th cells, such cells 1 x 107, 2.5 x 107, 5 x 107, 7.5 x 107 or 1 x 10º of these total cells or the range between two of the previous values. In some modalities, the patient receives multiple doses and each dose or the total dose can be within any of the previous values. In some embodiments, the cell dose comprises the administration of or about 1 x 107 to 0.75 x 10 th CD8 * T cells of total recombinant receptor expression, 1 x 10 th to 2.5 x 10 ”CD8 T cells * of expression of total recombinant receptors, of or of about 1 x 107 to 0.75 x 10º CD8 * T cells of expression of total recombinant receptors, each inclusive. In some embodiments, the cell dose comprises administration of about 1 x 10 7, 2.5 x 10 7, 5 x 10 7 7.5 x 10 7 or 1 x 10 T CD8 * cells of total recombinant receptor expression.
[00275] [00275] In some embodiments, the cell dose, for example, recombinant receptor expression T cells, is administered to the individual as a single dose or is administered only once within a period of two weeks, one month, three months , six months, | year or more.
[00276] [00276] In the context of adoptive cell therapy, the administration of a certain "dose" encompasses the administration of the quantity or number of cells specified as a single composition and / or single uninterrupted administration, for example, as a single injection or continuous infusion, and also encompasses administering the specified quantity or number of cells as a divided dose or as a plurality of compositions, delivered in various individual compositions or infusions, over a specified period of time, such as for a period not exceeding 3 days. In contexts, the dose is a single or continuous administration of the specified number of cells, administered or started at a single time. In some contexts, however, the dose is administered in several injections or infusions over a period not exceeding three days, such as once a day for three days or for two days or for multiple infusions over a single day.
[00277] [00277] Thus, in some respects, the dose cells are administered in a single pharmaceutical composition. In some embodiments, the dose cells are administered in a plurality of compositions, collectively containing the dose cells.
[00278] [00278] In some embodiments, the term "divided dose" refers to a dose that is divided so that it is administered for more than one day. This type of dosage is covered by the present methods and is considered a single dose.
[00279] [00279] Thus, the cell dose can be administered as a divided dose, for example, a divided dose administered over time. For example, in some modalities, the dose can be administered to the individual over 2 days or over 3 days. Exemplary methods for split dosing include administering 25% of the dose on the first day and administering the remaining 75% of the dose on the second day. In other modalities, 33% of the dose can be administered on the first day and the remaining 67% administered on the second day. In some aspects, 10% of the dose is administered on the first day, 30% of the dose is administered on the second day and 60% of the dose is administered on the third day. In some modalities, the divided dose is not spread over more than 3 days.
[00280] [00280] In some embodiments, the dose cells can be administered by administering a plurality of compositions or solutions, such as a first and a second, optionally more, each containing some cells of the dose. In some respects, the plurality of compositions, each containing a different population and / or cell subtypes, is administered separately or independently, optionally within a certain period of time. For example, cell populations or subtypes can include CD8 * and CD4 * T cells, respectively, and / or populations enriched in CD8 * and CD4 *, respectively, for example, CD4 * and / or CD8 * T cells, each of them individually, including cells genetically engineered to express the recombinant receptor. In some embodiments, administering the dose comprises administering a first composition comprising a dose of CD8 * T cells or a dose of CD4 * T cells and administering a second composition comprising the other dose of CD4 * T cell and CD8 * T cells.
[00281] [00281] In some embodiments, administration of the composition or dose, for example, administration of the plurality of cell compositions, involves administration of the cell compositions separately. In some respects, separate administrations are carried out simultaneously or sequentially, in any order. In some embodiments, the dose comprises a first composition and a second composition, and the first composition and the second composition are administered with a range of 0 to 12 hours, a range of 0 to 6 hours or a range of 0 to 2 hours. In some embodiments, the start of administration of the first composition and the start of administration of the second composition are carried out no more than 2 hours, no more than 1 hour or no more than 30 minutes separately, no more than 15 minutes, no more than 10 minutes or no more than 5 minutes. In some embodiments, the initiation and / or completion of administration of the first composition and the completion and / or initiation of administration of the second composition are carried out no more than 2 hours, no more than 1 hour or no more than 30 minutes separately , no more than 15 minutes, no more than 10 minutes, or no more than 5 minutes separately.
[00282] [00282] In some compositions, the first composition, for example, the first dose composition, comprises CD4 * T cells. In some composition, the first composition, for example, the first dose composition, comprises CD8 * T cells. In some embodiments, the first composition is administered before the second composition.
[00283] [00283] In some embodiments, the dose or composition of cells includes a defined or target ratio of CD4 * cells that express a recombinant receptor for CD8 * cells that express a recombinant receptor and / or CD4 * cells for CD8 * cells, whose ratio is optionally approximately 1: 1 or between approximately 1: 3 and approximately 3: 1, such as approximately 1: 1. In some respects, administration of a composition or dose with the desired or desired ratio of different cell populations (such as the CD4 *: CD8 * ratio or the RAQ * CD4 *: RAQ * CD8 * ratio, for example, 1: 1) involves administering a cell composition containing one population and then administering a separate cell composition comprising the other population , where the administration is at or approximately in the target or desired relationship. In some respects, administration of a dose or composition of cells in a defined relationship leads to improved expansion, persistence and / or anti-tumor activity of T-cell therapy.
[00284] [00284] In some embodiments, the individual receives multiple doses, for example, two or more consecutive doses or multiple doses, of the cells. In some embodiments, two doses are administered to an individual. In some modalities, the individual receives the consecutive dose, for example, second dose, approximately 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, are administered, 19, 20 or 21 days after the first dose. In some embodiments, several consecutive doses are administered after the first dose, so that an additional dose or doses are administered after the administration of the consecutive dose. In some respects, the number of cells administered to the individual at the additional dose is equal to or similar to the first dose and / or consecutive dose. In some embodiments, the additional dose or doses are higher than the previous doses.
[00285] [00285] In some respects, the size of the first and / or consecutive dose is determined based on one or more criteria, such as the individual's response to previous treatment, for example, chemotherapy, disease burden on the individual, such as tumor burden, volume , size or degree, extent or type of metastasis, stage and / or probability or incidence of the individual developing toxic results, for example, SLC, macrophage activation syndrome, tumor lysis syndrome, neurotoxicity and / or a host immune response against the cells and / or recombinant receptors being administered.
[00286] [00286] In some respects, the time between the administration of the first dose and the administration of the consecutive dose is about 9 to about 35 days, about 14 to about 28 days or 15 to 27 days. In some embodiments, administration of the consecutive dose is at a point in time more than about 14 days after and less than about 28 days after the administration of the first dose. In some respects, the time between the first and the consecutive dose is approximately 21 days. In some embodiments, an additional dose or doses, for example, consecutive doses, are administered after administration of the consecutive dose. In some respects, the additional consecutive dose or doses are administered at least about 14 and less than about 28 days after the administration of a previous dose. In some embodiments, the additional dose is administered less than about 14 days after the previous dose, for example, 4, 5, 6, 7, 8, 9, 10, 11, 12 or 13 days after the previous dose. In some embodiments, no dose is administered less than about 14 days after the previous dose and / or no dose is administered more than about 28 days after the previous dose.
[00287] [00287] In some embodiments, the cell dose, for example, recombinant receptor expression cells, comprises two doses (for example, a double dose), comprising a first dose of T cells and a consecutive dose of T cells, in that one or both of the first dose and the second dose comprises administration of the divided dose of T cells.
[00288] [00288] In some embodiments, the dose of cells is usually large enough to be effective in reducing the burden of the disease.
[00289] [00289] In some embodiments, the cells are administered in a desired dosage, which in some aspects includes a desired dose or number of cells or cell type (s) and / or a desired ratio of cell types. Thus, cell dosage in some modalities is based on a total number of cells (or number per kg of body weight) and a desired ratio of populations or individual subtypes, such as the CD4 * to CD8 * ratio. In some embodiments, cell dosage is based on a desired total number (or number per kg of body weight) of cells in the individual populations or in the individual cell types. In some embodiments, the dosage is based on a combination of such characteristics, such as a desired number of total cells, desired ratio and desired total number of cells in the individual populations.
[00290] [00290] In some embodiments, populations or subtypes of cells, such as CD8 * and CD4 * T cells, are administered at or within a tolerated difference of a desired dose from that of these total cells, such as a desired dose of T cells. In some aspects, the desired dose is a desired number of cells or a desired number of cells per unit of body weight of the individual to whom the cells are administered, for example, cells / kg. In some respects, the desired dose is equal to or greater than a minimum number of cells or minimum number of cells per unit of body weight. In some respects, between total cells, administered at the desired dose, individual populations or subtypes are present at or near a desired exit rate (such as the CD4 * to CD8 * ratio), for example, within a certain difference tolerated or error of this relationship.
[00291] [00291] In some embodiments, cells are administered at or within a tolerated difference of a desired dose of one or more of the individual populations or subtypes of cells, such as a desired dose of CD4 * cells and / or a desired dose of cells CD8 *. In some respects, the desired dose is a desired number of cells of the subtype or population, or a desired number of these cells per unit of body weight of the individual to which the cells are administered, for example, cells / kg. In some aspects, the desired dose is equal to or greater than a minimum number of cells in the population or subtype or minimum number of cells in the population or subtype per unit of body weight.
[00292] [00292] Thus, in some embodiments, the dosage is based on a desired fixed dose of total cells and a desired ratio, and / or a desired fixed dose of one or more, for example, each of the individual subtypes or subpopulations . Thus, in some embodiments, the dosage is based on a desired fixed or minimum dose of T cells and a desired ratio of CD4 * to CD8 * cells, and / or is based on a desired fixed or minimum dose of CD4 * cells and / or CD8 *.
[00293] [00293] In some embodiments, cells are administered in or within a tolerated range of a desired output rate of various populations or subtypes of cells, such as CD4 * and CD8 * cells or subtypes. In some ways, the desired relationship can be a specific relationship or a range of relationships. For example, in some embodiments, the desired ratio (for example, CD4 * to CD8 * cell ratio) is between or about 5: 1 and about 5: 1 (or greater than 5: 1 (or greater than about 1: 5 and less than about 5: 1), or between or about 1: 3 and about 3: 1 (or greater than 1: 3 and less than 3: 1), such as between or about 2: 1 and about 1: 5 (or greater than about 1: 5 and less than about 2: 1, such as or about 5: 1,4,5: 1,4: 1, 3,5: 1, 3: 1, 2.5: 1, 2: 1, 1.9: 1, 1.8: 1, 1.7:
[00294] [00294] In particular embodiments, cell numbers and / or concentrations refer to the number of recombinant receptor expression cells (e.g., RAQ). In other embodiments, the numbers and / or concentrations of cells refer to the number or concentration of all cells, T cells or peripheral blood mononuclear cells (PBMC) administered.
[00295] [00295] In some respects, the dose size is determined based on one or more criteria, such as the individual's response to previous treatment, for example, chemotherapy, disease burden on the individual, such as tumor burden, volume, size or grade, extent or type of metastasis, stage and / or probability or incidence of the individual developing toxic results, for example, SLC, macrophage activation syndrome, tumor lysis syndrome, neurotoxicity and / or a host immune response against cells and / or recombinant recipients being administered.
[00296] [00296] In some embodiments, the methods also include the administration of one or more additional doses of cells expressing a chimeric antigen receptor (RAQ) and / or lymph node therapy, and / or one or more steps of the methods are repeated . In some embodiments, the one or more additional doses is the same as the initial dose. In some embodiments, the one or more additional doses is different from the initial dose, for example, higher, such as 2 times, 3 times, 4 times, 5 times, 6 times, 7 times, 8 times, 9 times or 10 times or more than the starting dose or lower, such as higher, such as 2 times, 3 times, 4 times, 5 times, 6 times, 7 times, 8 times, 9 times or 10 times or more than the dose initial. In some modalities, the administration of one or more additional doses is determined based on the individual's response to the initial treatment or any previous treatment, disease burden on the individual, such as tumor burden, volume, size or degree, extent or type of metastasis , stage and / or probability or incidence of the individual to develop toxic results, for example, SLC, macrophage activation syndrome, tumor lysis syndrome, neurotoxicity and / or a host immune response against the cells and / or recombinant receptors being administered.
[00297] [00297] In some modalities, the administration effectively treats the individual, even though the individual has become resistant to another therapy. In some modalities, at least 30%, at least 35%, at least 40% or at least 50% of the individuals treated according to the method achieve complete remission (CR); and / or at least about 40%, at least about 50%, at least about 60% or at least about 70% of the subjects treated according to the method achieve an objective response (RO). In some embodiments, at least or about 50% of individuals, at least or about 60% of individuals, at least or about at least 70% of individuals, at least or about 80% of individuals or at least or about of at least 90 individuals treated according to the method achieve CR and / or achieve an objective response (OR). In some modalities, the criteria evaluated for effective treatment include general response rate (TRG; also known in some cases as objective response rate), complete response (CR; also known in some cases as complete response), duration of response ( PAIN), progression-free survival (SLP) and / or overall survival (SG).
[00298] [00298] In some modalities, at least 40% or at least 50% of individuals treated according to the methods provided here achieve complete remission (CR; also known in some cases as complete response), exhibit progression-free survival (SLP) and / or overall survival (SG) greater than approximately 3 months, 6 months or 12 months or greater than 13 months or approximately 14 months; on average, subjects treated according to the method exhibit a median SLP or SG greater than about 6 months, 12 months or 18 months; and / or the individual exhibits SLP or SG after therapy for at least approximately 6, 12, 18 or more months or more.
[00299] [00299] In some respects, response rates in individuals, such as individuals with NHL, are based on Lugano's criteria. (Cheson et a., (2014) JCO 32 (27): 3059-3067; Johnson et al., (2015) Radiology 2: 323-338; Cheson, BD (2015) Chin Clin Oncol 4 (1): 5 ). In some respects, response assessment uses any clinical, hematological and / or molecular method. In some respects, the response assessed using the Lugano criteria involves the use of computed tomography (CT) by positron emission tomography (PET) and / or computed tomography, as appropriate. PET-CT evaluations may also include the use of fluorodeoxyglucose (FDG) for lymphomas avid for FDG. In some respects, where PET-CT will be used to assess the response in histories hungry for FDG, a 5-point scale can be used. In some respects, the 5-point scale comprises the following criteria: 1, without funding above the base; 2, uptake <mediastinum; 3, uptake> mediastinum, but <liver; 4, moderate uptake> liver; 5, uptake markedly superior to the liver and / or new lesions; X, it is unlikely that new areas of uptake are related to lymphoma.
[00300] [00300] In some respects, a complete response, as described using the Lugano criteria, involves a complete metabolic response and a complete radiological response at various measurable sites. In some respects, these sites include lymph nodes and extralymphatic sites, where an RC is described as a score of 1, 2 or 3 with or without a residual mass on the 5-point scale, when PET-CT is used. In some aspects, in the Waldeyer ring or in extranodal sites with high physiological uptake or with activation in the spleen or medulla (for example, with chemotherapy or stimulating factors of myeloid colonies), uptake may be greater than the mediastinum and / or the liver normal. In this circumstance, the complete metabolic response can be inferred if the uptake at the sites of initial involvement is not greater than the surrounding normal tissue, even if the tissue has a high physiological uptake. In some respects, the response is assessed in the lymph nodes using CT, where a CR is described as no extralymphatic site of the disease and the target nodal nodes / masses must regress to <1.5 cm in the largest transverse diameter of an injury (LDi ). Other sites of assessment include bone marrow where the PET-CT based assessment should indicate a lack of evidence of avid FDG disease in the marrow and a CT based assessment should indicate a normal morphology which, if indeterminate, should be negative for IHC. Other sites may include an evaluation of organ augmentation, which should return to normal. In some respects, unmeasured injuries and new injuries are assessed, which, in the case of CR, should be absent (Cheson et a / l., (2014) JCO 32 (27): 3059-3067; Johnson et al., (2015) Radiology 2: 323-338; Cheson, BD (2015) Chin Clin Oncol 4 (1): 5).
[00301] [00301] In some respects, a partial response (PR; also known in some cases as partial remission), as described using the Lugano criteria, involves a partial metabolic and / or radiological response at various measurable sites.
[00302] [00302] In some aspects, progression-free survival (SLP) is described as the period of time during and after treatment of a disease, such as cancer, in which an individual lives with the disease, but does not get worse. In some respects, the objective response (RO) is described as a measurable response. In some respects, the objective response rate (ORT; also known in some cases as the general response rate) is described as the ratio of patients who have reached CR or PR. In some respects, overall survival (SG) is described as the period of time from the date of diagnosis or the start of treatment for a disease, such as cancer, when individuals diagnosed with the disease are still alive. In some respects, event-free survival (EFS) is described as the period of time after cancer treatment ends so that the individual remains free of certain complications or events that the treatment was intended to prevent or delay. These events can include the return of cancer or the appearance of certain symptoms, such as bone pain from cancer that has spread to the bone or death.
[00303] [00303] In some modalities, the measurement of the duration of the response (DOR) includes the time from the documentation of the tumor response to the progression of the disease. In some modalities, the parameter for evaluating the response may include a durable response, for example, a response that persists after a period of time since the start of therapy. In some modalities, the durable response is indicated by the response rate at approximately 1, 2, 3, 4, 5, 6.7, 8, 9, 10, 11, 12, 18 or 24 months after starting therapy. In some modalities, the response is durable for more than 3 months or more than 6 months.
[00304] [00304] In some respects, the RECIST criterion is used to determine the objective response of the tumor; in some respects, solid tumors. (Eisenhauer et al., European Journal of Cancer 45 (2009) 228-247.) In some respects, the RECIST criterion is used to determine the objective response of the tumor to target lesions. In some respects, a complete response, as determined by the RECIST criterion, is described as the disappearance of all target lesions and any pathological lymph node (target or non-target) must be reduced in the short axis to <10 mm. In other respects, a partial response, determined by the RECIST criterion, is described as a reduction of at least 30% in the sum of the diameters of the target lesions, taking as a reference the diameters of the sum of the baseline. In other respects, progressive disease (PD) is described as an increase of at least 20% in the sum of the diameters of the target lesions, taking as reference the smallest sum in the study (this includes the sum of the baseline, if it is the smallest in the study). In addition to the 20% relative increase, the sum must also demonstrate an absolute increase of at least 5 mm (in some respects, the appearance of one or more new lesions is also considered progression). In other respects, stable disease (ED) is not described as a sufficient retraction to qualify for PR nor a sufficient increase to qualify for PD, taking as reference the smallest sum diameters during the study.
[00305] [00305] In some respects, administration according to the methods provided and / or the articles of manufacture or compositions provided, generally reduces or prevents the expansion or burden of the disease or condition on the individual. For example, where the disease or condition is a tumor, the methods generally reduce the tumor size, volume, metastasis, percentage of blasts in the bone marrow or molecularly detectable cancer and / or improve the prognosis or survival or other symptom associated with the burden tumor.
[00306] [00306] The disease burden may include a total number of disease cells in the individual or in an individual's organ, tissue or body fluid, such as the tumor organ or tissue or other location, for example, which would indicate metastasis. For example, tumor cells can be detected and / or quantified in the blood or bone marrow in the context of certain hematological neoplasms. The burden of the disease may include, in some modalities, the mass of a tumor, the number or extent of metastasis and / or the percentage of blast cells present in the bone marrow.
[00307] [00307] In some modalities, an individual has leukemia. The extent of the disease burden can be determined by assessing residual leukemia in the blood or bone marrow.
[00308] [00308] In some respects, response rates in individuals, such as individuals with CLL, are based on the response criteria of the International Workshop on Chronic Lymphocytic Leukemia (IWCLL) (Hallek et a /., Blood 2008, June 15; 111 (12): 5446-5456). In some respects, these criteria are described below: complete remission (CR; also known in some cases as complete response), which in some respects requires the absence of peripheral blood clonal lymphocytes by immunophenotyping, absence of lymphadenopathy, absence of hepatomegaly or splenomegaly absence of constitutional symptoms and satisfactory blood count; complete remission with incomplete spinal cord recovery (CRi), which in some aspects is described as CR above, but without a blood count; partial remission (PR; also known in some cases as a partial response), which in some ways is described as 2 50% drop in lymphocyte count, = 50% reduction in lymphadenopathy or 2 50% reduction in liver or spleen, along with improvement in peripheral blood count; progressive disease (PD), which in some aspects is described as> 50% increase in lymphocyte count to> 5 x 10% L,> 50% increase in lymphadenopathy, 2 50% increase in the size of the liver or spleen, transformation Richter's or new cytopenias due to CLL; and stable disease, which in some aspects is described as not meeting the criteria of CR, RCi, PR or DP.
[00309] [00309] In some modalities, individuals exhibit CR or RO if, within 1 month after administration of the cell dose, the lymph nodes in the individual are less than or equal to 20 mm, less than or equal to 10 mm or less than or equal to 10 mm.
[00310] [00310] In some modalities, a CLL index clone is not detected in the individual's bone marrow (or in the bone marrow greater than 50%, 60%, 70%, 80%, 90% or more of the individuals treated according to In some modalities, a CLL index clone is evaluated by deep IgH sequencing In some modalities, the index clone is not detected at a time that is equal to, or close to, or at least equal to 1, 2, 3, 4, 5, 6, 12, 18 or 24 months after cell administration.
[00311] [00311] In some modalities, an individual exhibits morphological disease if there are blasts greater than or equal to 5% in the bone marrow, for example, as detected by optical microscopy, such as blasts greater than or equal to 10% in the bone marrow, greater or equal to 20% of the blasts in the bone marrow, greater than or equal to 30% of the blasts in the bone marrow, greater than or equal to 40% of the blasts in the bone marrow or greater than or equal to 50% of the blasts in the bone marrow to the bone marrow. In some modalities, an individual exhibits complete or clinical remission if there is less than 5% of blasts in the bone marrow.
[00312] [00312] In some modalities, an individual has leukemia. The extent of the disease burden can be determined by assessing residual leukemia in the blood or bone marrow.
[00313] [00313] In some modalities, an individual exhibits morphological disease if there are blasts greater than or equal to 5% in the bone marrow, for example, as detected by optical microscopy, such as blasts greater than or equal to 10% in the bone marrow, greater or equal to 20% of the blasts in the bone marrow, greater than or equal to 30% of the blasts in the bone marrow, greater than or equal to 40% of the blasts in the bone marrow or greater than or equal to 50% of the blasts in the bone marrow to the bone marrow. In some modalities, an individual exhibits complete or clinical remission if there is less than 5% of blasts in the bone marrow.
[00314] [00314] In some modalities, an individual may exhibit complete remission, but a small ratio of residual leukemic cells morphologically undetectable (by light microscopy techniques) is present. An individual is said to exhibit minimal residual disease (MRD) if the individual exhibits less than 5% of blasts in the bone marrow and exhibits molecularly detectable cancer. In some embodiments, molecularly detectable cancer can be evaluated using any of a variety of molecular techniques that allow for the sensitive detection of a small number of cells. In some ways, these techniques include PCR assays, which can determine unique rearrangements of Ig / T cell receptor genes or fusion transcripts produced by chromosomal translocations. In some embodiments, flow cytometry can be used to identify cancer cells based on specific leukemia immunophenotypes. In some modalities, molecular cancer detection can detect up to 1 leukemia cell in
[00315] [00315] In some modalities, a leukemia index clone, for example, CLL, is not detected in the individual's bone marrow (or in the bone marrow greater than 50%, 60%, 70%, 80%, 90% or more of individuals treated according to the methods. In some modalities, a leukemia index clone, for example, CLL, is assessed by profound IGH sequencing. In some modalities, the index clone is not detected at a time that is equal to or greater at least 1, 2, 3, 4, 5, 6, 12, 18, or 24 months after cell administration.
[00316] [00316] In some aspects, MRD is detected by flow cytometry. Flow cytometry can be used to monitor bone marrow and peripheral blood samples from cancer cells. In particular, flow cytometry is used to detect or monitor the presence of cancer cells in the bone marrow. In some respects, multiparameter immune detection by flow cytometry is used to detect cancer cells (see, for example, Coustan-Smith et al., (1998) Lancet 351: 550-554). In some respects, multiparameter immune detection by mass cytometry is used to detect cancer cells. In some examples, 1, 2,3,4,5,6,7,8,9,10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45 or 50 parameters can be used to detect cancer cells. The antigens used for detection are selected based on the cancer being detected (Foon and Todd (1986) Blood 68: 1 - 31).
[00317] [00317] In some examples, the bone marrow is harvested by aspirates or bone marrow biopsies, and the lymphocytes are isolated for analysis. Monoclonal and / or polyclonal antibodies conjugated to a fluorochrome (eg, fluorescein isothiocyanate (FITC), phytoerythrin, peridinine chlorophyll protein or biotin) can be used to detect epitopes, such as terminal deoxynucleotidyl transferase (TdT), CD3, CD10, CD11c , CD13, CD14, CD33, CD19, CD20, CD21, CD22, CD23, CD34, CD45, CD56, CD79b, IgM and / or KORSA3544, in isolated lymphocytes. The labeled cells can then be detected using flow cytometry, such as multiparameter flow cytometry, or mass cytometry, to detect various epitopes.
[00318] [00318] Lymphoid cells can be identified and blocked based on a light scattering plot and subsequently blocked to identify cell populations expressing the immunophenotypic characteristics of interest. Exemplary epitopes are shown in Table 2 below. Another immune classification of leukemias and lymphomas is provided by Foon and Todd (Blood (1986) 68 (1): 1 - 31). In some aspects, the cytometric evaluation of MRD flow can be achieved by quantifying live lymphocytes with one or more CLL immunophenotypes (for example, low front / side dispersion; CD3 "º9; CD5 *; CD14" ºs; CD19 * ; CD23 *; CD45 *; CD56 "*").
[001] [001] GIS: surface immunoglobulins
[002] [002] cylg: cytoplasmic immunoglobulins
[00319] [00319] In some respects, deep sequencing of the immunoglobulin heavy chain (IGH) site of harvested B cells can be used to detect minimal residual disease (MRD). The clonal presence of a specific IgG rearrangement may provide a marker to detect the presence of B cell neoplasms, such as CLL or NHL and / or residual presence of malignant cells. In some ways, cells such as a population that contains or is suspected to contain B cells are harvested and isolated from the blood. In some respects, cells are harvested and isolated from bone marrow, for example, from bone marrow aspirates or biopsies and / or other biological samples. In some respects, polymerase chain reaction (PCR) amplification of the complementarity-determining region 3 (CDR3) is achieved using primers for highly conserved sequences in the V and J regions of the gene site, which can be used to identify clonal populations cells to assess minimal residual disease. Other methods for detecting clonal populations, such as single cell sequencing approaches, including those that provide information on the number of cells in a specific lineage and / or that express a specific variable chain, such as a variable heavy chain or binding site, as a clonal population, can be used. In some respects, the IGH DNA is amplified using degenerate primers or primers that recognize variable chain regions shared between different cell clones, such as those that recognize the V consensus and the degenerate consensus J region of the IGH sequence. An exemplary sequence from region V is ACACGGCCTCGTGTATTACTGT (SEQ ID NO: 57). An exemplary degenerate consensus sequence from region J is ACCTGAGGAGACGGTGACC (SEQ | D NO: 58).
[00320] [00320] The PCR product or the sequencing result in some aspects is specific to the reorganized allele and serves as a clonal marker for the detection of MRD. After PCR amplification of the CDR3 region, PCR products can be sequenced to produce patient-specific oligonucleotides constructed as probes for allele-specific PCR for sensitive detection of MRD after treatment of B-cell malignancies with RAQ-T cell therapy , for example, CD19 cell therapy RAQ-T. In examples where a PCR product is not generated using the consensus primers, primers specific to the V region family for structure 1 region can be used.
[00321] [00321] In some respects, the persistence of tumor cells detectable by PCR, such as B cell malignancy cells, such as LNH or CLL, as detectable IGH sequences corresponding to the malignant or clonal IGH sequences, after treatment is associated with a increased risk of relapse. In some respects, patients who are negative for malignant IGH sequences after treatment (in some respects, even in the context of other criteria that indicate progressive disease or only a partial response, such as persistent enlarged lymph nodes or other criteria that may in some contexts may be associated with disease or a lack of complete response) may be considered to have an increased likelihood of SLP or to enter CR or durable CR or prolonged survival, compared to patients with persistent IGH malignant sequences. In some embodiments, these prognostic and staging determinations are particularly relevant for treatments in which the clearance of malignant cells is observed within a short period of time after administration of the therapy, for example, compared to the resolution of other clinical symptoms, such as lymph node size or other preparation criteria. For example, in some of these respects, the absence of detectable IGH or minimal residual disease in a sample such as bone marrow may be a preferred reading for response or probability of response or durability of the sample, compared to other available staging or prognosis approaches . In some respects, MRD results, for example, IGH profound sequencing information, may inform an additional intervention or lack thereof. For example, the methods and other modalities provided in some contexts provide that an individual considered negative for malignant IGH may, in some respects, be no longer treated or given another dose of the therapy provided, or that the individual be given a dose lower or reduced. On the other hand, it may be provided or specified that an individual who displays MRD via deep IGH sequencing be treated later, for example, with therapy initially administered at a similar or higher dose or with additional treatment. In some aspects, the disease or condition persists after the administration of the first dose and / or the administration of the first dose is not sufficient to eradicate the disease or condition in the individual.
[00322] [00322] In some modalities, the method reduces the burden of the disease or condition, for example, number of tumor cells, tumor size, duration of patient survival or event-free survival, to a greater degree and / or for a longer period time compared to the reduction that would be seen with a comparable method using an alternative dosage regimen, such as one in which the individual receives one or more alternative therapeutic agents and / or in which the individual does not receive a dose of cells and / or an agent lymph node depletion according to the methods provided and / or the articles of manufacture or compositions provided. In some modalities, the burden of a disease or condition on the individual is detected, assessed or measured. The disease burden can be detected in some ways by detecting the total number of diseases or disease-associated cells, for example, tumor cells, in the individual, or in an individual's organ, tissue or body fluid, such as blood or serum. In some respects, the individual's survival, survival within a certain period of time, the extent of survival, the presence or duration of event-free or symptom-free survival, or relapse-free survival, is assessed. In some modalities, any symptom of the disease or condition is assessed. In some modalities, the measure of the burden of disease or condition is specified.
[00323] [00323] In some embodiments, the event-free survival rate or the individual's overall survival rate is improved by the methods, compared to other methods, for example, methods in which the individual receives one or more alternative therapeutic agents and / or one in which the individual does not receive a dose of cells and / or a lymph node eliminating agent according to the methods provided and / or the articles of manufacture or compositions provided. For example, in some modalities, the event-free survival rate or probability for individuals treated by the methods at 6 months after the dose is greater than about 40%, greater than about 50%, greater than about 60 %, greater than about 70%, greater than about 80%, greater than about 90% or greater than about 95%. In some ways, the overall survival rate is greater than about 40%, greater than about 50%, greater than about 60%, greater than about 70%, greater than about 80%, greater than about 90% or greater than about 95%. In some modalities, the individual treated with the methods exhibits event-free survival, relapse-free survival or survival for at least 6 months or at least 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 years. In some modalities, the time for progression is improved, such as a time for progression greater than about 6 months or at least 1, 2, 3, 4, 5,6,7,8,9 or 10 years.
[00324] [00324] In some modalities, after treatment by the method, the likelihood of relapse is reduced compared to other methods, for example, methods in which the individual receives one or more alternative therapeutic agents and / or one in which the individual does not receive receiving a dose of cells and / or a lymph node eliminating agent according to the methods provided and / or the articles of manufacture or compositions provided. For example, in some modalities, the probability of relapse at 6 months after the first dose is less than about 80%, less than about 70%, less than about 60%, less than about 50%, less than about 40%, less than 30%, less than about% or less than about 10%.
[00325] [00325] In some cases, the pharmacokinetics of administered cells, for example, cells transferred adoptively, are determined to assess the availability, for example, bioavailability of the administered cells. Methods for determining the pharmacokinetics of adoptively transferred cells may include drawing peripheral blood from individuals who have been given modified cells and determining the number or ratio of the modified cells in the peripheral blood. Approaches to selecting and / or isolating cells may include the use of antibodies specific for chimeric antigen receptors (RAQ) (eg, Brentjens et al., Sci. Transl. Med. 2013 mar; 5 (177): 177ra38) Protein L (Zheng et al., J. Transl. Med. 2012 Feb; 10:29), epitopic markers, such as Strep-Tag sequences, introduced directly at specific sites in the RAQ, through which Strep-Tag binding reagents are used to directly assess RAQ (Liu et al. (2016) Nature Biotechnology, 34: 430; international patent application! Pub. No. WOZ2015095895) and monoclonal antibodies that specifically bind to a RAQ polypeptide (see patent application International Pub. No. WOZ2014190273). In some cases, extrinsic marker genes can be used in conjunction with cell therapies modified to allow the detection or selection of cells and, in some cases, also to promote cell suicide. A truncated epidermal growth factor receptor (EGFRt) in some cases can be coexpressed with a transgene of interest (an RAQ or RCT) in transduced cells (see, for example, U.S. Patent No.
[00326] [00326] In some embodiments, the number of ells in a biological sample obtained from the patient, for example, blood, can be determined within a period of time after the administration of cell therapy, for example, to determine the pharmacokinetics of the cells. In some embodiments, the number of RAQ T cells ”, optionally RAQ * CD8 * cells and / or RAQ * CD4 'T cells, detectable in the individual's blood, or in most individuals treated by the method, is greater than 1 cells per uL, greater than 5 cells per ul or greater than 10 cells per JL. D. Toxicity
[00327] [00327] In some embodiments, the methods provided are designed to or include features that result in a lower rate and / or less degree of toxicity, toxic result or symptom, profile, factor or property that promotes toxicity, such as a symptom or associated or indicative result of cytokine release syndrome (SLC) or neurotoxicity, for example, compared to the administration of an alternative cell therapy, such as an alternative T RAQ * cell composition and / or an alternative dose of cells, for example, a dosage of cells that is not administered in a defined relationship.
[00328] [00328] In some embodiments, the methods provided do not result in a high rate or probability of toxicity or toxic results, nor do they reduce the rate or probability of toxicity or toxic results, such as neurotoxicity (NT), cytokine release syndrome (SLC) , as compared to other cell therapies. In some modalities, the methods do not result in, or do not increase, the risk of severe NT (NTg), severe SLC (SLCg), macrophage activation syndrome, tumor lysis syndrome, fever of at least 38 degrees Celsius or approximately three or more days and a plasma CRP level of at least approximately 20 mg / dL. In some modalities, greater or greater than about 30%, 35%, 40%, 50%, 55%, 60% or more of the individuals treated according to the methods provided do not exhibit any degree of SLC or any degree of neurotoxicity . In some modalities, no more than 50% of treated individuals (for example, at least 60%, at least 70%, at least 80%, at least 90% or more of treated individuals) exhibit a cytokine release syndrome (SLC ) greater than grade 2 and / or a neurotoxicity greater than grade 2. In some modalities, at least 50% of individuals treated according to the method (eg at least 60%, at least 70%, at least 80%, at least 90% or more of treated individuals) do not have a serious toxic result (eg severe SLC or severe neurotoxicity), as they do not expose grade 3 or higher neurotoxicity and / or do not have severe or not severe SLC in a given period of time after treatment, such as within a week, two weeks, or a month after cell administration. In some embodiments, the parameters assessed to determine certain toxicities include adverse events (AEs), dose-limiting toxicities (DLTs), SLC and NT.
[00329] [00329] Administration of adoptive T cell therapy, such as treatment with T cells that express chimeric antigen receptors, can induce toxic effects or results, such as cytokine release syndrome and neurotoxicity. In some instances, these effects or results are parallel to the high levels of circulating cytokines, which may be underlying the observed toxicity.
[00330] [00330] In some aspects, the toxic result is or is associated with or is indicative of cytokine release syndrome (SLC) or severe SLC (SLCg). SLC, for example, SLCg, can occur in some cases after therapy and administration of adoptive T cells to individuals of other biological products. See, Davila et al., Sci Trans! Med 6, 224ra25 (2014); Brentjens et a /., Sci. Transl. Med. 5, 177ra38
[00331] [00331] Typically, SLC is caused by an exaggerated systemic immune response mediated by, for example, T cells, B cells, NK cells, monocytes and / or macrophages. Such cells can release a large number of inflammatory mediators, such as cytokines and chemokines. Cytokines can trigger an acute inflammatory response and / or induce damage to endothelial organs, which can result in microvascular leakage, heart failure or death. Severe and life-threatening SLC can lead to pulmonary infiltration and lung injury, renal failure or disseminated intravascular coagulation. Other serious and life-threatening toxicities may include cardiac toxicity, difficulty breathing, neurological toxicity and / or liver failure.
[00332] [00332] SLC can be treated using anti-inflammatory therapy, such as anti-IL-6 therapy, for example, anti-IL-6 antibody, for example, tocilizumab or antibiotics or other agents, as described. Results, signs and symptoms of SLC are known and include those described herein. In some modalities, where a particular dosage or administration regimen affects or does not affect a given result, sign or symptom associated with SLC, specific results, signs and symptoms and / or the quantities or degrees thereof can be specified.
[00333] [00333] In the context of administering RAQ expression cells, SLC generally occurs 6 to 20 days after infusion of RAQ expression cells. See, Xu et al., Cancer Letters 343 (2014) 172-78. In some cases, SLC occurs less than 6 days or more than days after the infusion of RAQ T cells. The incidence and timing of SLC may be related to baseline levels of cytokines or tumor burden at the time of infusion. Commonly, SLC involves high serum levels of interferon (IFN) -y, tumor necrosis factor (TNF) - a and / or interleukin (IL) -2. Other cytokines that can be rapidly induced in SLC are IL-16, IL-6, IL-8 and 11-10.
[00334] [00334] Exemplary results associated with SLC include fever, stiffness, chills, hypotension, dyspnea, acute respiratory distress syndrome (ARDS), encephalopathy, ALT / AST elevation, renal failure, cardiac disorders, hypoxia, neurological disorders and death. Neurological complications include delirium, seizure activity, confusion, difficulty in finding words, aphasia and / or obturation. Other results related to SLC include fatigue, nausea, headache, seizure, tachycardia, myalgia, skin rash, acute vascular leak syndrome, impaired liver function and renal failure. In some aspects, SLC is associated with an increase in one or more factors such as serum ferritihna, d-dimer; aminotransferases, lactate dehydrogenase and triglycerides, or hypofibrinogenemia or hepatosplenomegaly. Other exemplary signs or symptoms associated with SLC include hemodynamic instability, febrile neutropenia, increased serum C-reactive protein (CRP), changes in coagulation parameters (eg, international normalized ratio (INR), prothrombin time (PTI) and / or fibrinogen)), changes in cardiac and other organ function and / or absolute neutrophil count (CAN).
[00335] [00335] In some embodiments, the results associated with SLC include one or more of the following: persistent fever, for example, fever of a specified temperature, for example, greater than or about 38 degrees Celsius, by two or more, for for example, three or more, for example, four or more days or for at least three consecutive days; fever greater than or equal to 38 degrees Celsius; elevation of cytokines, such as a maximum fold change, for example, of at least about 75, compared to pretreatment levels of at least two cytokines (for example, at least two in the group consisting of gamma interferon ( IFNy), GM -CSF, IL-6, I1L-10, FIt-3L, fracktalkine and IL-5 and / or tumor necrosis factor alpha (TNFa)) or a maximum doubling change, for example, of at least at least about 250 at least one of these cytokines; and / or at least one clinical sign of toxicity, such as hypotension (for example, as measured by at least one intravenous vasoactive pressor); hypoxia levels (for example, plasma oxygen levels (PO2) below about 90%); and / or one or more neurological disorders (including changes in mental status, obtundation and seizures).
[00336] [00336] Exemplary results related to SLC include increased or elevated serum levels of one or more factors, including cytokines and chemokines and other factors associated with SLC. Exemplary results also include increases in the synthesis or secretion of one or more of these factors. This synthesis or secretion can be by the T cell or a cell that interacts with the T cell, such as an innate immune cell or a B cell.
[00337] [00337] In some embodiments, serum factors associated with SLC or SLC-related results include inflammatory cytokines and / or chemokines, including gamma interferon (IFN-y), TNF-a, IL-16, IL-2, IL-6 , IL-7, IL-8, I1L-10, I1L-12, sIL-2Ra, granulocyte and macrophage colony stimulating factor (GM-CSF), macrophage inflammatory protein (PIM) -1, tumor necrosis factor alpha (TNFα), IL-6 and I1L-10, IL-16B, IL-8, I1L-2, MIP-1, FIt-3L, fracktalkine and / or IL-5. In some embodiments, the factor or outcome includes C-reactive protein (CRP). In addition to being an early and easily measurable risk factor for SLC, CRP is also a marker for cell expansion. In some modalities, individuals who are measured to have high levels of CRP, such as 2 15 mg / dL, have SLC. In some modalities, individuals who are measured to have high CRP levels do not have SLC. In some embodiments, a measure of SLC includes a measure of CRP and another factor indicative of SLC.
[00338] [00338] In some modalities, one or more inflammatory cytokines or chemokines are monitored before, during or after treatment with RAQ. In some respects, the one or more cytokines or chemokines include IFN-y, TNF-a, IL-2, IL-16, IL-6, IL-7, IL-8, IL-10, II-12, syll- 2Ra, granulocyte and macrophage colony stimulating factor (GM-CSF) or macrophage inflammatory protein (PIM). In some modalities, IFN-y, TNF-a and IL-6 are monitored.
[00339] [00339] SLC criteria that appear to correlate with the onset of SLC to predict which patients are most at risk of developing SLCg have been developed (see Davilla et al. Science translational science. 2014; 6 (224): 224ra25). Factors include fever, hypoxia, hypotension, neurological changes, elevated serum levels of inflammatory cytokines, such as a set of seven cytokines (IFNy, IL-5, IL-6, IL-10, FIt-3L, fractalkine and GM-CSF) whose treatment-induced elevation may correlate well with pre-treatment tumor burden and symptoms of SLCg. Other guidelines on the diagnosis and treatment of SLC are known (see, for example, Lee et al, Blood. 2014; 124 (2): 188-95). In some modalities, the reflective criteria of the degree of SLC are those detailed in Table 3 below. Mild symptomatic, such as antipyretics and antiemetics (eg, fever, nausea, fatigue, headache, myalgia, malaise)
[00340] [00340] In some embodiments, an individual is considered to develop "severe SLC" ("SLCg") in response to or secondary to the administration of a cell therapy or dose of cells thereof, if, after administration, the individual exhibits: ( 1) fever of at least 38 degrees Celsius for at least three days; (2) cytokine elevation which includes (a) a maximum change of at least 75 by at least two of the following seven groups of seven cytokines compared to the level immediately after administration: gamma interferon (IFNy), GM-CSF, IL -6, I1L-10, FIt-3L, fracktalkine and IL-5 and / or (b) a maximum change of at least 250 for at least one of the seven groups of seven cytokines below the level immediately after administration: interferon gamma (IFNy), GM-CSF, IL-6, 11-10,
[00341] [00341] In some embodiments, the results associated with severe SLC or SLC grade 3 or higher, such as grade 4 or higher, include one or more of the following: persistent fever, for example, fever of a specified temperature, for example, higher that at or near 38 degrees Celsius, for two or more, for example, three or more, for example, four or more days or for at least three consecutive days; fever greater than or equal to 38 degrees Celsius; elevation of cytokines, such as a maximum fold change, for example, of at least about 75, compared to pretreatment levels of at least two cytokines (for example, at least two in the group consisting of gamma interferon ( IFNy), GM -CSF, IL-6, I1L-10, FIt-3L, fracktalkine and IL-5 and / or tumor necrosis factor alpha (TNFa)) or a maximum doubling change, for example, of at least at least about 250 at least one of these cytokines; and / or at least one clinical sign of toxicity, such as hypotension (for example, as measured by at least one intravenous vasoactive pressor); hypoxia levels (for example, plasma oxygen levels (PO) less than about 90%); and / or one or more neurological disorders (including changes in mental status, obtundation and seizures). In some modalities, severe SLC includes SLC that requires management or care in the intensive care unit (ICU).
[00342] [00342] In some modalities, SLC, such as severe SLC, encompasses a combination of (1) persistent fever (fever of at least 38 degrees Celsius for at least three days) and (2) a serum CRP level of at least at or about 20 mg / dL. In some modalities, SLC encompasses hypotension that requires the use of two or more vasopressors or respiratory failure that requires mechanical ventilation. In some embodiments, the dosage of vasopressors is increased with a second or subsequent administration.
[00343] [00343] In some embodiments, severe SLC or grade 3 SLC encompasses an increase in alanine aminotransferase, an increase in aspartate aminotransferase, chills, febrile neutropenia, headache, left ventricular dysfunction, encephalopathy, hydrocephalus and / or tremor.
[00344] [00344] The method of measuring or detecting the various results can be specified.
[00345] [00345] In some aspects, the toxic result is or is associated with neurotoxicity. In some modalities, symptoms associated with a clinical risk of neurotoxicity include confusion, delirium, aphasia, expressive aphasia, obtundation, myoclonus, lethargy, altered mental status, seizures, seizure-like activity, seizures (optionally as confirmed by the electroencephalogram [EEG] ), high levels of beta amyloid (AB), high levels of glutamate and high levels of oxygen radicals. In some embodiments, neurotoxicity is classified based on severity (for example, using a 1 - 5 grade scale (see, for example, Guido Cavaletti and Paola Marmiroli Nature Reviews Neurology 6, 657-666 (December 2010); National Cancer Institute - Common toxicity criteria version 4.03 (NCI-CTCAE v4.03).
[00346] [00346] In some cases, neurological symptoms may be the first symptoms of SLCg. In some modalities, neurological symptoms are seen starting 5 to 7 days after the infusion of cell therapy. In some modalities, the duration of neurological changes can vary from 3 to 19 days. In some cases, recovery from neurological changes occurs after resolution of other symptoms of SLCg. In some modalities, the time or degree of resolution of neurological changes is not accelerated by treatment with anti-IL-6 and / or steroid (s).
[00347] [00347] In some modalities, an individual is considered to develop "severe neurotoxicity" in response to or secondary to the administration of a cell therapy or dose of her cells, if, after administration, the individual exhibits symptoms that limit self-care (eg example, bathing, dressing and undressing, feeding, using the bathroom, taking medication) among: 1) symptoms of peripheral motor neuropathy, including inflammation or degeneration of peripheral motor nerves; 2) symptoms of peripheral sensory neuropathy, including inflammation or degeneration of peripheral sensory nerves, dysesthesia, such as distortion of sensory perception, resulting in an abnormal and unpleasant sensation, neuralgia, such as intense painful sensation along a nerve or group of nerves and / or paresthesia, such as functional disturbances of sensory neurons, resulting in abnormal skin sensations of tingling, numbness, pressure, cold and heat in the absence of stimulation. In some modalities, severe neurotoxicity includes neurotoxicity with a grade of 3 or higher, as set out in Table 4. [Example 4 Classical Ert5nos for neurothorality - |) 1 Mild or asymptomatic symptoms Asymptomatic or Mild 2 Presence of symptoms that limit symptoms Moderate instrumental activities of daily living (ADL), such as preparing meals, shopping or buying clothes, using the phone, managing money
[00348] [00348] In some embodiments, the methods reduce symptoms associated with SLC or neurotoxicity compared to other methods. In some respects, the methods provided reduce symptoms, results or factors associated with SLC, including symptoms, results or factors associated with severe SLC or SLC grade 3 or higher, compared to other methods. For example, individuals treated according to the present methods may have no detectable and / or have reduced symptoms, results or factors of SLC, for example, severe SLC or SLC grade 3 or higher, as anyone described, for example, established in Table 3. In some modalities, individuals treated according to the present methods may have reduced symptoms of neurotoxicity, such as weakness or numbness in the limbs, loss of memory, vision and / or intellect, uncontrollable obsessive and / or compulsive behaviors, delusions , headache, cognitive and behavioral problems, including loss of motor control, cognitive impairment and dysfunction of the autonomic nervous system and sexual dysfunction, compared to individuals treated by other methods. In some modalities, individuals treated according to the present methods may have reduced symptoms associated with peripheral motor neuropathy, peripheral sensory neuropathy, dysplasia, neuralgia or paresthesia.
[00349] [00349] In some modalities, the methods reduce the results associated with neurotoxicity, including damage to the nervous system and / or brain, such as the death of neurons. In some ways, the methods reduce the level of factors associated with neurotoxicity, such as beta-amyloid (AB), glutamate and oxygen radicals.
[00350] [00350] In some embodiments, the result of toxicity is a dose-limiting toxicity (DLT). In some embodiments, the toxic result is dose-limiting toxicity. In some embodiments, the toxic result is the absence of dose-limiting toxicity. In some embodiments, a dose-limiting toxicity (DLT) is defined as any grade 3 or higher toxicity, assessed by any known or published guidelines for assessing specific toxicity, such as any described above and including the Common Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
[00351] [00351] In some embodiments, the low rate, risk or likelihood of developing a toxicity, for example, SLC or severe neurotoxicity or SLC or neurotoxicity, for example, SLC or neurotoxicity grade 3 or higher, seen with the administration of a dose of T cells according to the methods provided and / or the articles of manufacture or compositions provided, allows the administration of cell therapy on an outpatient basis. In some embodiments, the administration of cell therapy, for example, The dose of T cells (for example, T cells RAQ *), according to the methods provided and / or the articles of manufacture or compositions provided, is carried out at a level outpatient or does not require admission of the patient to the hospital, such as admission to the hospital that requires an overnight stay.
[00352] [00352] In some respects, subjects administered cell therapy, for example, The dose of T cells (eg, T cells RAQ *) according to the methods provided and / or the articles of manufacture or compositions provided, including individuals treated on an outpatient basis, receive no intervention to treat any toxicity before or with administration of the cell dose, unless or until the individual exhibits a sign or symptom of a toxicity, such as a neurotoxicity or SLC. Exemplary agents for treating, delaying, mitigating or ameliorating a toxicity are described in Section | l.
[00353] [00353] In some embodiments, if an individual has administered cell therapy, for example, the dose of T cells (eg, T cells RAQ +), including individuals treated on an outpatient basis, exhibits fever that the individual receives or is instructed to receive or administer treatment to reduce fever. In some embodiments, the individual's fever is characterized as an individual's body temperature that is (or is measured at) at or above a certain level or limit temperature. In some aspects, the threshold temperature is that associated with at least a low fever, with at least a moderate fever and / or with at least a high-grade fever. In some embodiments, the limit temperature is a specific temperature or range. For example, the limit temperature can be at or about or at least at or about 38, 39, 40, 41 or 42 degrees Celsius, and / or it can be a range of a or about 38 degrees Celsius at or about 39 degrees Celsius, a range of a or about 39 degrees Celsius to or about 40 degrees Celsius, a range of about a or about 40 degrees Celsius to or about 41 degrees, or a range of 41 degrees Celsius to or about 42 degrees Celsius or at or about 42 degrees Celsius.
[00354] [00354] In some modalities, the treatment designed to reduce fever includes treatment with an antipyretic. An antipyretic can include any agent, for example, compound, composition or ingredient, that reduces fever, as one of any number of agents known to have antipyretic effects, such as NSAIDs (such as ibuprofen, naproxen, ketoprofen and nimesulide), salicylates, such such as aspirin, choline salicylate, magnesium salicylate and sodium salicylate, acetaminophen, acetaminophen, metamizole, Nabumetona, Phenaxona, antipyrine, febrifuges. In some embodiments, the antipyretic is acetaminophen. In some modalities, acetaminophen can be administered at a dose of 12.5 mg / kg orally or intravenously up to every four hours. In some embodiments, it is or comprises ibuprofen or aspirin.
[00355] [00355] In some modalities, if the fever is a prolonged fever, the individual receives an alternative treatment for the treatment of toxicity, as anyone described in Section | below. For individuals treated on an outpatient basis, the individual is instructed to return to the hospital if the individual has and / or is determined to or has a prolonged fever. In some modalities, the individual has, and / or is determined or considered to have a prolonged fever if he exhibits a fever at or above the relevant threshold temperature and where the individual's fever or body temperature is not reduced, or is not reduced at or in more than a specified amount (for example, more than 1 "Ce generally does not vary by about 0.5 ºC, 0.4 ºC, 0.3 ºC or 0.2 ºC) after a specified treatment , as a treatment designed to reduce fever, such as treatment with an antipyretic, for example, NSAID or salicylates, for example, ibuprofen, acetaminophen or aspirin. For example, an individual is considered to have a prolonged fever if he exhibits or is determined to exhibit a fever of at least about 38 or 39 degrees Celsius, or approximately, which is neither reduced nor further reduced than or about 0.5 ºC, 0.4 ºC, 0.3 ºC or 0.2 "ºC, or per or about 1%, 2%, 3%, 4% or 5%, over a period of 6 hours , over a period of 8 hours, or over a period of 12 hours, or over a period of 24 hours, even after treatment with antipyretics, such as acetaminophen. In some embodiments, the dosage of the antipyretic is a dosage normally effective in such an individual to reduce fever or fever of a particular type, such as fever associated with a bacterial or viral infection, for example, a localized or systemic infection.
[00356] [00356] In some modalities, the individual has, and / or is determined or considered to have a prolonged fever if he exhibits a fever at or above the relevant threshold temperature and where the individual's fever or body temperature does not fluctuate by, or more than about 1 "ºC, and generally does not fluctuate around, or more than about 0.5 ºC, 0.4 ºC, 0.3 ºC or 0.2 ºC. This absence of fluctuation above or in a certain amount is usually measured over a period of time (such as a period of 24 hours, 12 hours, 8 hours, 6 hours, 3 hours or 1 hour in duration), which can be measured from the first sign of fever or the first temperature above the indicated threshold). For example, in some embodiments, an individual is considered or determined to exhibit a prolonged fever if he exhibits a fever of at least approximately = or approximately or at least approximately 38 or 39 degrees Celsius, which does not vary in temperature more than or about 0.5 "ºC, 0.4 ºC, 0.3 ºC or 0.2 ºC, over a period of 6 hours, over a period of 8 hours, or over a period of 12 hours or over a period of 24 hours.
[00357] [00357] In some modalities, fever is a prolonged fever; in some respects, the individual is treated at the time an individual was determined to have a prolonged fever, such as within one, two, three, four, five six or less hours of that determination or the first determination after initial potential therapy to induce toxicity, such as cell therapy, such as the dose of T cells, for example, T cells RAQ *.
[00358] [00358] In some modalities, one or more interventions or agents for the treatment of toxicity, such as toxicity targeting therapies, are administered at the time when or immediately after which the individual is determined or confirmed (as is the first determined or confirmed) exhibits prolonged fever, for example, as measured according to any of the modalities mentioned above. In some embodiments, one or more toxicity targeting therapies are administered within a certain period of time for such confirmation or determination, such as 30 minutes, 1 hour, 2 hours, 3 hours, 4 hours, 6 hours or 8 hours of this . E. Biomarkers, Analyzes or Parameters
[00359] [00359] Among the methods provided are risk assessment methods for the development of toxicity associated with cell therapy in an individual that involves assessing or detecting biomarkers (eg, analyzed) or parameters that are associated with toxicity, for example, neurotoxicity, such as severe neurotoxicity and / or SLC, as severe SLC. Also among the methods provided are methods for assessing the likelihood of a cell therapy response in an individual that involves assessing or detecting biomarkers (for example, analyzed) or parameters associated with a response outcome, such as an objective response including a complete response ( RC) and partial response (PR). In some modalities, the result of the associated response includes a durable response, such as a response lasting 3 months, 6 months, 9 months, 12 months or more, after the initial response.
[00360] [00360] In some modalities, the methods involve evaluating or detecting the presence or absence of one or a panel of biomarkers (for example, analyzed) and / or parameters (for example, concentration, quantity, level or activity) associated with one or a panel of biomarkers (for example, analyzed). In some cases, methods may include comparing one or more parameters to a specific reference value, such as a threshold level (also called a "threshold value"), for example, those associated with a risk of developing toxicity or those associated to a specific response, such as RO, RC or RP, or durable response, such as a lasting response for 3 months, 6 months, 9 months 12 months or more, after the initial response. In some modalities, the methods also involve selecting individuals for treatment with cell therapy based on assessing the presence or absence of the biomarker and / or comparing the biomarkers with a reference value or threshold level of the biomarker. In some embodiments, the methods also involve the administration of an agent or therapy that can treat, prevent, delay and / or mitigate the development of toxicity, for example, based on assessing the presence or absence of the biomarker and / or comparing the biomarkers to a reference value or threshold level of the biomarker.
[00361] [00361] In some modalities, the methods involve assessing the likelihood of an individual's response or the risk of developing a toxicity after administration of cell therapy. In some “modalities, the methods involve assessing the level, quantity or concentration of one or more analyzed in a biological sample, where the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells. In some aspects, the methods involve comparing, individually, the level, quantity or concentration of the analyzed in the sample with a threshold level, thereby determining the risk of developing toxicity after the administration of cell therapy. In some respects, comparisons can be used to determine the likelihood of an individual's response or the risk of developing toxicity after administration of cell therapy.
[00362] [00362] In some embodiments, the methods also involve selecting individuals for treatment with a cell therapy, such as a specific dose of cell therapy, including administering a specific dose of cell therapy, such as those described here, for example, in Section IA and IB, based on the assessment of the presence or absence of the biomarker and / or comparison of the biomarkers with a reference value or threshold level of the biomarker. In some embodiments, the methods also involve selecting individuals for treatment with an additional agent, such as an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity, based on the assessment the presence or absence of the biomarker and / or comparison of the biomarkers with a reference value or threshold level of the biomarker.
[00363] [00363] In some modalities, the parameter is or includes attributes, factors, characteristics of the patient and / or the disease or condition. In some modalities, the parameter is a parameter related to tumor load, for example, a measurement of tumor load. In some aspects, the methods also involve additional monitoring of the individual for possible toxicity symptoms based on the toxicity risk determined by assessing the presence or absence of the biomarker and / or comparing the biomarkers with a reference value or Em threshold level. some aspects, a biological sample, for example, blood sample or tissue sample from the individual, can be obtained to detect the presence or absence of a biomarker (for example, analyzed), such as to detect or measure a parameter (for example, concentration, quantity, level or activity) of the biomarker and / or evaluation of the presence of a biomarker, for analysis, correlation and / or detection of particular results and / or toxicities.
[00364] [00364] In some embodiments, a biomarker or analyte is an objectively measurable characteristic or a molecule expressed by or in a biological sample, including cells, which can be indicative or associated with a specific state or phenomenon, such as a biological process, a therapeutic result, a cell phenotype or a sick state. In some respects, a biomarker or analyzed or parameters associated with a biomarker or analyzed can be measured or detected. For example, the presence or absence of expression of a biomarker or analyzed, can be detected. In some aspects, parameters such as concentration, quantity, level or activity of the biomarker or analyzed can be measured or detected. In some modalities, the presence, absence, expression, concentration, quantity, level and / or activity of the biomarker can be associated with, correlated with, indicative and / or predictive of particular states, such as specific therapeutic results or individual's state. In some respects, the presence, absence, expression, concentration, quantity, level and / or activity of the biomarker or analyzed, like any described here, can be used to assess the likelihood of a specific outcome or condition, such as a particular therapeutic outcome , including response result or toxicity result. In some embodiments, exemplary biomarkers include cytokines, cell surface molecules, chemokines, receptors, soluble receptors, soluble serum proteins and / or degradation products. In some modalities, biomarkers or analyzed may also include particular attributes, factors, characteristics of the patient and / or the disease or condition or factors indicative of the patient's condition and / or the disease or condition of the patient (including the disease burden) and / or clinical or laboratory parameters.
[00365] [00365] In some modalities, biomarkers can be used alone or in combination with other biomarkers, as in a panel of biomarkers. In some embodiments, the expression of particular biomarkers can be correlated with particular results or toxicities, for example, development of neurotoxicity. In some modalities, biomarkers (for example, analyzed), including their parameters, that can be evaluated include Lactate dehydrogenase (LDH), ferritin, C-reactive protein (PCR), Interleukin-6 (IL-6), IL-7, IL-8, IL-10, IL-15, I1L-16, tumor necrosis factor alpha (TNF-a), interferon alpha 2 (IFN-a2), monocyte chemo attractant protein-1 (MCP-1), inflammatory protein macrophage 1 alpha (MIP-10), macrophage inflammatory protein 1 beta (MIP-1B), Eotaxin, granulocyte colony stimulating factor (G-CSF), IL-1 alpha receptor (IL-1Ra), IL-1B, IFN-y-inducible protein (IP-10), perforin and D-dimer (fibrin degradation product). In some embodiments, biomarkers (for example, analyzed), including parameters thereof, include LDH, ferritin, CRP, IL-6, IL-8, IL-8, 11-10, TNF-a, IFN-a02, MCP -1 and MIP-1B. In some embodiments, biomarkers (for example, analyzed), including their parameters, include ferritin, CRP, D-dimer, IL-6, IL-15, TNF-a and MIP-10. In some embodiments, biomarkers (for example, analyzed), including their parameters, include ferritin, CRP, IL-10, IL-15, IL-16, TNF-a or MIP-1B.
[00366] [00366] In some modalities, the methods include detecting the presence or absence of one or more biomarkers, as a parameter (for example, concentration, quantity, level or activity) associated with one or more biomarkers, in which the one or more biomarkers are selected from Lactate dehydrogenase (LDH), ferritin, C-reactive protein (PCR), Interleukin-6 (IL-6), IL-7, IL-8, IL-10, IL-15, I1L-16, tumor necrosis factor alpha (TNF-a), interferon alpha 2
[00367] [00367] In some modalities, the parameter that is evaluated is or includes attributes, factors, characteristics of the patient and / or the disease or condition and / or expression of biomarkers. In some embodiments, the parameter is or includes one or more factors indicative of the patient and / or the patient's illness or condition. In some modalities, the parameter is indicative of the tumor burden. In some modalities, the tumor load factor is a volumetric measurement of the tumor (s). In some modalities, the volumetric measure is a measure of the lesion (s), such as tumor size, tumor diameter, tumor volume, tumor mass, tumor load or volume, tumor-related edema, tumor-related edema tumor, tumor-related necrosis and / or number or extent of metastases. In some embodiments, the tumor volume measurement is a two-dimensional measurement. For example, in some modalities, the area of the lesion (s) is calculated as the product of the longest diameter and the longest perpendicular diameter of all measurable tumors. In some cases, the volumetric measurement of the tumor is a one-dimensional measurement. In some cases, the size of the measurable lesions is assessed as the largest diameter. In some modalities, the sum of the products of diameters (SPD), longest tumor diameters (LD), sum of the longest tumor diameters (SLD), necrosis, tumor volume, necrosis volume, necrosis-tumor ratio (NTR ), peritumoral edema (TEP) and the edema-tumor ratio (ETR) is measured.
[00368] [00368] “Exemplary methods for measuring and assessing tumor burden include those described in, for example, Carceller et a / l., Pediatr Blood Cancer. (2016) 63 (8): 1400-1406 and Eisenhauer et al., Eur J. Cancer. (2009) 45 (2): 228-247. In some modalities, the volumetric is a sum of the products of diameters (SPD) measured determining the sum of the products of the largest perpendicular diameters of all measurable tumors. In some respects, the tumor or lesion is measured in a dimension with the largest diameter (LD) and / or by determining the sum of the longest tumor diameters (SLD) of all measurable lesions. In some modalities, the tumor volume measurement is a volumetric quantification of tumor necrosis, such as volume of necrosis and / or necrosis-tumor ratio (NTR), see, Monsky et a., Anticancer Res. (2012) 32 (11) : 4951-4961. In some aspects, the volumetric measurement of the tumor is a volumetric quantification of edema related to the tumor, such as peritumoral edema (TEP) and / or edema-tumor relationship (ETR). In some modalities, the measurement can be performed using imaging techniques, such as computed tomography (CT), positron emission tomography (PET) and / or magnetic resonance imaging (MRI) of the individual.
[00369] [00369] In some modalities, the volumetric measurement of the tumor is determined in a screening session, such as a routine evaluation or blood collection to confirm and / or identify the condition or disease in the individual.
[00370] [00370] In some modalities, the presence or absence and / or a parameter of one or more biomarkers (for example, analyzed) are evaluated from a biological sample. In some ways, the biological sample is a body fluid or tissue. In some of these modalities, the biological sample, for example, body fluid, is or contains whole blood, serum or plasma.
[00371] [00371] In some modalities, the presence or absence and / or a parameter of one or more biomarkers (for example, analyzed) are evaluated before the administration of cell therapy (for example, pre-infusion), for example, obtained up to 2 days, up to 7 days, up to 14 days, up to 21 days, up to 28 days, up to 35 days or up to 40 days before the start of administration of the modified cells. In some modalities, the biological sample is obtained from the individual before administration of cell therapy (for example, pre-infusion), for example, obtained up to 2 days, up to 7 days, up to 14 days, up to 21 days, up to 28 days, up to 35 days or up to 40 days before the start of the administration of the modified cells.
[00372] [00372] In some embodiments, the biological sample is an apheresis or leukopheresis sample. In some modalities, the or absence and / or a parameter of one or more biomarkers (for example, analyzed) are evaluated or the biological sample is obtained after the administration of cell therapy. In some embodiments, the reagents may be used prior to the administration of cell therapy or after the administration of cell therapy, for diagnostic purposes, to identify individuals and / or to evaluate treatment results and / or toxicities.
[00373] [00373] In some modalities, measuring the value of one or more biomarkers includes performing an in vitro test. In some respects, the in vitro assay is an immunoassay, an aptamer-based assay, a histological or cytological assay or an mMRNA expression level assay. In some embodiments, the values of one or more biomarkers are measured by an enzyme-linked immunosorbent assay (ELISA), immunoblotting, immunoprecipitation, radioimmunoassay (RIA), immunoblotting, a flow cytometry assay, surface plasmon resonance (SPR), a chemiluminescence assay, a side flow immunoassay, an inhibition assay or an avidity assay. In some cases, the value of at least one of the one or more biomarkers is determined using a binding reagent that specifically binds to at least one biomarker. In some respects, the binding reagent is an antibody or its antigen binding fragment, an aptamer or a nucleic acid probe.
[00374] [00374] In some modalities, measuring the value of one or more biomarkers (for example, analyzed) comprises the contact of a reagent capable of directly or indirectly detecting the analyzed with the biological sample and determining the presence or absence, level, quantity or concentration of the analyzed in the biological sample. In some embodiments, the one or more biomarkers (for example, analyzed) is lactate dehydrogenase (LDH), ferritin, CRP, IL-6, IL-7, IL-8, 11-10, IL-15, I1L-16, TNF-alpha, IFN-gamma, MCP-1, MIP-1beta, eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, IP-10, perforin and D-dimer (fibrin degradation product). In some embodiments, the one or more biomarkers (for example, analyzed) is LDH, ferritin, CRP, IL-6, IL-8, 11-10, TNF-alpha, IFN-alpha2, MCP-1 and MIP-1beta. In some embodiments, the one or more biomarkers (for example, analyzed) is or includes LDH.
[00375] [00375] In some aspects, the reagent is a binding molecule that binds specifically to the analyzed. For example, in some embodiments, the reagent is an antibody or an antigen-binding fragment thereof. In some embodiments, the reagent is or includes a substrate or binding partner of the analyte.
[00376] [00376] In some modalities, the presence, absence or parameter (for example, level, quantity, concentration and / or other measure) of LDH is detected or determined in a sample. Several methods are known to detect or determine LDH. For example, an assay that measures the conversion of LDH from lactate to pyruvate by reducing NAD * to NADH can be used to detect LDH in the sample. In some embodiments, the sample is contacted with lactate in the presence of the NAD coenzyme which, as a measure of LDH in the sample, results in NADH which is oxidized in the presence of an electron transfer agent. In some embodiments, NADH interacts with a dye probe or precursor that is detectable by measuring absorption in a visible light band. In some examples, diaphorase uses NADH to reduce the tetrazolium salt (INT) to a red formazan product and the product is measured. Therefore, in some modalities, the amount of colored product formed is directly proportional to the LDH activity in the sample.
[00377] [00377] In some modalities, the methods involve comparing, individually, the level, quantity or concentration of the analyzed in the sample with a threshold level, thereby determining a risk of developing a toxicity after the administration of cell therapy or, thus, determining a likelihood that an individual will respond to cell therapy. In some respects, exemplary threshold levels can be determined based on the mean or median values and values within a range or standard deviation of the mean or median values of the level, quantity or concentration of the analyzed in a biological sample obtained from a group of individuals before receiving cell therapy, in which each of the individuals in the group exhibited a specific result, such as a specific therapeutic result, including showing a response or not; or developing toxicity or not developing toxicity. In some embodiments, particular aspects of determining limit values include those described below in Sections 1.E.1 and 1.E.2.
[00378] [00378] In some modalities, the analyzed or biomarker is associated, correlated to, indicative and / or predictive of a specific result, such as a specific response result, such as an objective response (RO), a complete response (RC) or a partial response (PR) or durable response, such as an RO or RC or a durable PR for 3, 6, 9 months or more. In some modalities, lower or reduced levels or increased levels of one or more of these biomarkers (for example, analyzed), as compared to a reference value or threshold level, can be associated with the response to, such as an RO, RC or RP , or any response results described herein, for example, in Section IC, optionally a durable response, such as a lasting response for at least 3 months, 6 months or more.
[00379] [00379] In some modalities, the analyzed or biomarker is associated with, correlated with, indicative and / or predictive of a specific result, such as a specific response or result of a durable response, in an individual to whom cell therapy has been administered, such as with a composition containing genetically modified cells. In some modalities, the presence, expression, level, quantity or concentration of one or more analyzed in a biological sample obtained from an individual before the administration of cell therapy, may be associated, correlated with, indicative and / or predictive of a specific result , as a specific response or as a result of a durable response. In some modalities, the presence, expression, level, quantity or concentration of specific biomarkers can be correlated with a specific response or result of a durable response. In some embodiments, the response result can be any response result described here, for example, in Section | 1.C.
[00380] [00380] In some modalities, the methods include the comparison, individually, of the level, quantity or concentration of the analyzed in the sample with a threshold level, thus determining the probability that an individual will achieve a response to cell therapy. In some embodiments, the methods include selecting an individual who is likely to respond to treatment based on the results of determining the likelihood that an individual will respond to cell therapy by individually comparing the level, quantity, or concentration of the analyzed in the sample to a threshold level. In some embodiments, the methods also include administering cell therapy to the individual selected for treatment. In some embodiments, if the individual is determined to be unlikely to obtain a response or a lasting response, further comprising administering an additional therapeutic agent to the individual.
[00381] [00381] In some modalities, biomarkers (eg, analyzed) include those associated with a response result and / or a durable response In some modalities, biomarkers (eg, analyzed), including their parameters, include LDH, ferritin , CRP, D-dimer, serum amyloid A1 (SAA-1), IL-6, I1L-10, IL-15, I1L-16, Chemokine with motif TNF-a, IFN-y, MIP-1a and CXC 10 (CXCL10 ).
[00382] [00382] In some respects, examples of assays or biomarkers that can be assessed or analyzed with respect to assessing the likelihood of response after administration of cell therapy include one or more assays selected from ferritin, LDH, CXCL10, G-CSF and 11-10 In some modalities, for any of the analyzed or biomarkers mentioned above, the individual is likely to get a response if the level, quantity or concentration of one or more analysts is below a threshold level and the individual is unlikely to get a response. response if the level, quantity or concentration of one or more analyzed above a threshold level. In some modalities, the answer is or comprises objective answer In some modalities, the objective answer is or comprises complete answer (RC) or partial answer (RP). In some respects, reduced levels of ferritin, LDH, CXCL10, G-CSF and IL-10, in a biological sample from an individual obtained prior to administration of cell therapy (pre-treatment), may be associated with obtaining a response objective response, including complete response (RC) or partial response (PR).
[00383] [00383] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and / or within a standard deviation below the median or average level , amount or concentration of ferritin, LDH, CXCL10, G-CSF or IL-10 in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual in the group was able to obtain a response after administration of a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition. In some embodiments, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and / or within a standard deviation above the median or average level, quantity or concentration of ferritin, LDH, CXCL10, G-CSF or IL-10 in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual in the group started to exhibit stable disease (ED) and / or progressive disease (PD) after administration of a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00384] [00384] In some respects, examples of assays or biomarkers that can be assessed or analyzed with respect to assessing the likelihood of a durable response after administration of cell therapy include one or more assays selected from LDH, ferritin, CRP, D-dimer, SAA-1, IL-6, II-10, II-15, IL-16, TNF-a, IFN-y, MIP-10, CXCL-10, IL-8, MCP-1 and MIP-1B. In some modalities, for any of the aforementioned analyzed or biomarkers, the individual is likely to achieve a lasting response if the level, quantity or concentration of one or more analyzed is below a threshold level and the individual is not likely to reach a durable response if the level, quantity or concentration of one or more analyzed is above a threshold level. In some embodiments, the durable response is either comprised of a complete response (CR) or partial response (PR) that is durable for at least 3 months, 4 months, 5 months or 6 months. In some embodiments, the durable response is or comprises an RC or PR that is durable for at least 3 months. In some ways, reduced levels of LDH, ferritin, PCR, D-dimer, SAA-1, IL-6, I1L-10, I1L-15, IL-16, TNF-a, IFN-y, MIP-1a, CXCL - 10, IL-8, MCP-1 and MIP-16, in a biological sample from an individual obtained before the administration of a cell therapy (pre-treatment), may be associated with obtaining a durable response, such as a CR or PR that it is durable for at least 3 months.
[00385] [00385] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 11% or within 5%, and / or within a standard deviation below the median level or medium, amount or concentration of LDH, ferritin, PCR, D-dimer, SAA-1, IL-6, 11-10, IL-15, II-16, TNF-a, IFN-y, MIP-10, CXCL-10 , IL-8, MCP-1 or MIP-16 in a biological sample obtained from a group of individuals before receiving cell therapy, where each of the individuals in the group proceeded to obtain a lasting response after administration of a cell composition therapy that expresses the recombinant receptor for the treatment of the same disease or condition.
[00386] [00386] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 11% or within 5% and / or within a standard deviation above the median or average level , amount or concentration of LDH, ferritin, CRP, D-dimer, SAA-1, IL-6, II-10, IL-15, IL-16, TNF-a, IFN-y, MIP-10, CXCL-10, IL-8, MCP-1 or MIP-16 in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual in the group did not achieve a lasting response after administration of a therapeutic cell composition that expresses the recombinant receptor to treat the same disease or condition.
[00387] [00387] In some modalities, the answer is a durable answer, such as an RC or PR that is durable for at least 3 months.
[00388] [00388] In some modalities, the threshold level for LDH is equal to or less than or less than 600 U / L, 500 U / L, 400 U / L, 300 U / L or 200 U / L.
[00389] [00389] In some embodiments, the exemplary threshold level for ferritin is less than or equal to about 1000 µg / L, 900 µg / L, 800 µg / L, 700 µg / L, 600 µg / L, 500 µg / L L, 400 ug / L, 300 upg / L or 200 ug / L.
[00390] [00390] In some embodiments, the exemplary threshold level for CRP is 20 mg / L, 19 mg / L, 18 mg / L, 17 mg / L, 17 mg / L, 16 mg / L or less , 15 mg / L, 14 mg / L, 13 mg / L, 12 mg / L, 11 mg / L, 10 mg / L, 9 mg / L, 8 mg / L, 7 mg / L, 6 mg / L or 5 mg / L.
[00391] [00391] In some embodiments, the exemplary threshold level for the D-dimer is 1000 ug / L, 900 ug / L, 800 ug / L, 800 ug / L, 700 ug / L, 600 ug / L, 500 µg / L, 400 µg / L, 300 µg / L or 200 µg / L.
[00392] [00392] In some embodiments, the exemplary threshold level for SAA-1 is less than or equal to about 100 mg / L, 90 mg / L, 80 mg / L, 70 mg / L, 60 mg / L, 50 mg / L, 40 mg / L, 30 mg / L or 20 mg / L.
[00393] [00393] In some embodiments, the exemplary threshold level for IL-6 is less than or equal to about 6 pg / mL, 5 pg / mL, 4 pg / mL, 3 P9g / mL or 2 pg / mL.
[00394] [00394] In some embodiments, the exemplary threshold level for IL- is equal to or less than or less than about 2 pgmL, 1 pg / mL, 0.9 pg / mL, 0.8 pg / mL, 0.7 pg / ml, 0.6 pg / ml or 0.5 pg / ml.
[00395] [00395] In some embodiments, the exemplary threshold level for IL- is 7 pg / ml or less, 6 pg / ml, 5 pg / ml, 4 pg / ml or 3 pg / ml.
[00396] [00396] In some embodiments, the exemplary threshold level for IL-16 is less than or equal to about 1000 pg / mL, 900 pg / mL, 800 pg / mL, 700 pg / mL or 600 pg / mL.
[00397] [00397] In some embodiments, the exemplary threshold level for TNF-a is less than or equal to about 10 pg / ml, 9 pg / ml, 8 pg / ml, 7 pg / ml or 6 pg / ml.
[00398] [00398] In some embodiments, the exemplary threshold level for IFN-y is less than or equal to about 30 pg / mL, 20 pg / mL, 10 P9 / mL, 9 pg / mL, 8 pg / mL or 7 pg / ml.
[00399] [00399] In some embodiments, the exemplary threshold level for MIP-1a is equal to or less than or less than about 40 pg / mL, 30 pg / mL or pg / mL. and / or
[00400] [00400] In some embodiments, the exemplary threshold level for CXCL-10 is equal to or less than about 1500 pg / mL, 1000 Pg / mL, 900 pg / mL, 800 pg / mL, 700 pag / mL, 600 pg / ml or 500 pg / ml.
[00401] [00401] In some respects, specimens or biomarkers that can be evaluated or analyzed with respect to assessing the likelihood of a durable response after administration of a cell therapy include one or more assays selected from ferritin, CRP, LDH, CXCL10, IL- 8, IL-10, IL-15, MCP-1, MIP-18 and
[00402] [00402] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 11% or within 5% and / or within a standard deviation below the median or average level , amount or concentration of ferritin, PCR, LDH, CXCL10, IL-8, IL-10, IL-15, MCP-1, MIP-168 or TNF-a in a biological sample obtained from a group of individuals before receiving a cell therapy, in which each individual in the group achieved a durable response after administration of a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00403] [00403] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 11% or within 5% and it is within a standard deviation above the median or average level, quantity or concentration of ferritin, CRP, LDH, CXCL10, IL-8, I1L-10, IL-15, MCP-1, MIP-18 or TNF-a in a biological sample obtained from a group of individuals before receiving cell therapy , in which each of the individuals in the group did not achieve a lasting response after administration of a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00404] [00404] In some respects, specimens or biomarkers that can be evaluated or analyzed in relation to the assessment of the probability of a durable response after the administration of a cell therapy include one or more analyzed selected from hemoglobin and albumin. In some modalities, for any of the aforementioned analyzed or biomarkers, the individual is likely to achieve a lasting response if the level, quantity or concentration of one or more analyzed is above a threshold level and the individual is not likely to achieve a durable response if the level, quantity or concentration of one or more analyzed is below a threshold level. In some embodiments, the durable response is either comprised of a complete response (CR) or partial response (PR) that is durable for at least 3 months, 4 months, 5 months or 6 months. In some embodiments, the durable response is or comprises an RC or PR that is durable for at least 3 months. In some respects, elevated levels of hemoglobin and albumin, in a biological sample from an individual obtained prior to administration of cell therapy (pre-treatment), may be associated with obtaining a durable response, such as a CR or a durable PR for at least 3 months.
[00405] [00405] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 11% or within 5% and it is within a standard deviation above the median or average level, quantity or concentration of hemoglobin or albumin in a biological sample obtained from a group of individuals before receiving cell therapy, in which each of the individuals in the group achieved a durable response after administration of a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00406] [00406] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 11% or within 5% and / or within a standard deviation below the median or average level , amount or concentration of hemoglobin or albumin in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual in the group did not obtain a lasting response after administration of a therapeutic cell composition that expresses the receptor recombinant for the treatment of the same disease or condition.
[00407] [00407] In some modalities, the analyzed or biomarker is associated with, correlated with, indicative and / or predictive of a specific result, such as the development of toxicity, in an individual who has been given cell therapy, as with a composition containing genetically modified cells. In some modalities, the presence, expression, level, quantity or concentration of one or more analyzed in a biological sample obtained from an individual before the administration of cell therapy, may be associated, correlated with, indicative and / or predictive of a specific result , such as the development of a toxicity, like any toxicity results described here, for example, in Section | .D. In some modalities, the presence, expression, level, quantity or concentration of specific biomarkers can be correlated with particular results or toxicities, for example, development of NT or SLC. In some embodiments, toxicity is a toxicity potentially associated with cell therapy, such as any described here, for example, in Section | .D. In some modalities, the toxicity is neurotoxicity (NT) or cytokine release syndrome (SLC). In some embodiments, toxicity is a severe NT or a severe SLC. In some embodiments, toxicity is grade 2 or higher NT or grade 2 or higher SLC. In some embodiments, toxicity is grade 3 or higher NT or SLC grade 3 or higher.
[00408] [00408] In some modalities, the methods include comparing, individually, the level, quantity or concentration of the analyzed in the sample with a threshold level, thereby determining a risk of developing toxicity after the administration of cell therapy. In some embodiments, the methods include identifying an individual who is at risk of developing toxicity after administering cell therapy based on individually comparing the level, quantity or concentration of the analyzed in the sample to a threshold level. In some embodiments, the methods also include following or based on the results of the assessment, administering cell therapy to the individual and, optionally, an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing toxicity. In some modalities, the methods also involve monitoring the individual for symptoms of toxicity if the individual receives cell therapy and is identified as having a risk of developing toxicity.
[00409] [00409] In some embodiments, if the individual is identified as having a risk of developing toxicity, one or more of the following steps can be performed can be administered to the individual: (a) (1) an agent or other treatment capable of treating , preventing, delaying, reducing or mitigating the development or risk of developing a toxicity and (2) cell therapy, in which administration of the agent must be administered (i) before, (ii) within one, two, or three days, (ili) concomitantly with and / or (iv) in the first fever after the start of administration of cell therapy to the individual; and / or (b) giving the individual cell therapy at a reduced dose or at a dose that is not associated with the risk of developing serious toxicity or toxicity, or is not associated with the risk of developing severe toxicity or toxicity in a majority of individuals and / or the majority of individuals with a disease or condition that the individual has or is suspected to have after administration of cell therapy; and / or (c) administration of cell therapy to the patient in a hospital environment and / or with admission to the hospital for one or more days, optionally in which the cell therapy is otherwise to be administered to patients on an outpatient basis or without admission at the hospital for one or more days.
[00410] [00410] In some modalities, biomarkers or analyzed, including parameters thereof, which can be evaluated include Lactate dehydrogenase (LDH), ferritin, C-reactive protein (PCR), Interleukin-6 (IL-6), IL-7, IL -8, 11-10, IL-15, I1L-16, tumor necrosis factor alpha (TNF-a), interferon alpha 2 (IFN-02), “monocyte (MCP-1) chemoattractive protein-1, inflammatory protein macrophage 1 alpha (MIP-10), macrophage inflammatory protein 1 beta (MIP-1B), Eotaxin, granulocyte colony stimulating factor (G-CSF), IL-1 alpha receptor (IL-1Ra), IL-1B, inducible by IFN-y Protein (IP-10), perforin and D-dimer (fibrin degradation product). In some embodiments, biomarkers (for example, analyzed), including parameters thereof, include LDH, ferritin, CRP, IL-6, IL-8, IL-8, 11-10, TNF-a, IFN-a02, MCP -1 and MIP-18B. In some embodiments, biomarkers (for example, analyzed), including their parameters, include ferritin, CRP, D-dimer, IL-6, IL-15, TNF-a and MIP-10. In some embodiments, biomarkers (for example, analyzed), including their parameters, include ferritin, CRP, IL-10, IL-15, IL-16, TNF-a or MIP-1B. In some embodiments, high levels or increased levels of one or more of these biomarkers (for example, biomarkers), as compared to a reference value or threshold level, may be associated with the development of neurotoxicity, for example severe neurotoxicity or grade 3 neurotoxicity or higher or 4 or 5. In some modalities, high levels or increased levels of one or more of these biomarkers (for example, analyzed), as compared to a reference value or threshold level, may be associated with the development of neurotoxicity, for example neurotoxicity severe or neurotoxicity grade 3 or higher or 4 or 5.
[00411] [00411] In some respects, specimens or biomarkers that can be evaluated or analyzed with respect to assessing the risk of developing toxicity after administration of cell therapy include one or more assays selected from LDH, ferritin, C-reactive protein (CRP), IL-6, IL-8, 11-10, TNF-a, IFN-02, MCP-1 and MIP-1B. In some embodiments, for any of the aforementioned analyzed or biomarkers, the individual is at risk of developing toxicity if the level, quantity or concentration of one or more of the analyzed is above a threshold level and the individual has a low risk of developing a toxicity if the level, quantity or concentration of one or more analyzed is below a threshold level. In some embodiments, toxicity is neurotoxicity. In some respects, elevated levels of LDH, ferritin, C-reactive protein (PCR), IL-6, IL-8, IL-10, TNF-a, IFN-a2, MCP-1 and MIP-1B, in an environment biological The sample from an individual obtained prior to the administration of cell therapy (pre-treatment) may be associated with an increased risk of developing neurotoxicity.
[00412] [00412] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 30% or within 5% and / or within a standard deviation above the median or average level , an assembly or concentration of LDH, ferritin, C-reactive protein (PCR), IL-6, IL-8, IL-10, TNF-a, IFN-a02, MCP-1 or MIP-16 in a biological sample obtained from a group of individuals before receiving cell therapy, in which each of the individuals in the group did not develop any toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00413] [00413] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 30% or within 5% and / or within a standard deviation below the median or average level , amount or concentration of LDH, Ferritin, C-reactive protein (PCR), IL-6, IL-8, IL-10, TNF-a, IFN-a2, MCP-1 or MIP-16 in a biological sample obtained from a group of individuals before receiving cell therapy, in which each of the individuals in the group developed toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00414] [00414] In some modalities, toxicity is neurotoxicity.
[00415] [00415] In some modalities, the exemplary threshold level for LDH is equal to or higher than or equal to 300 U / L, 400 U / L, 500 U / L, 600 U / L or 700 U / L.
[00416] [00416] In some embodiments, the exemplary threshold level for Ferritin is equal to or greater than 500 ng / mL, 600 ng / mL, 700 ng / mL, 800 ng / mL, 900 ng / mL, 1000 ng / mL mL or 1500 ng / ml.
[00417] [00417] In some embodiments, the exemplary threshold level for CRP is equal to or greater than 20 mg / L, 30 mg / L, 40 mg / L, 50 mg / L, 60 mg / L, 60 mg / L, 70 mg / L or 80 mg / L.
[00418] [00418] In some embodiments, the exemplary threshold level for IL-6 is equal to or greater than 5 pg / mL, 6 pg / mL, 7 pg / mL, 8 pg / mL, 9 pg / mL, 10 Pg / mL, 20 pg / ml or 30 pg / ml.
[00419] [00419] In some embodiments, the exemplary threshold level for IL-8 is equal to or greater than or equal to 8 pg / ml, 9 pg / ml, 10 pg / ml, 20 P9g / ml or 30 pg / ml.
[00420] [00420] In some embodiments, the exemplary threshold level for IL- is equal to or greater than 20 pg / mL, 30 pg / mL, 40 pg / mL, 50 pg / mL, 60 Pg / mL or 70 pg / mL.
[00421] [00421] In some embodiments, the exemplary threshold level for TNF-a is equal to or greater than or greater than about 20 pg / ml or 30 Pg9 / ml.
[00422] [00422] In some embodiments, the exemplary threshold level for IFN-a2 is 40 pg / mL, 50 pg / mL, 60 pg / mL, 70 pg / mL or 80 pg / mL.
[00423] [00423] In some modalities, exemplary threshold level for MCP-1; and / or is equal to or greater than 200 pg / ml or 300 pg / ml.
[00424] [00424] In some embodiments, the exemplary threshold level for MIP-18 is 40 pg / mL, 50 pg / mL, 60 pg / mL, 70 pg / mL or 80 pg / mL.
[00425] [00425] In some respects, specimens or biomarkers that can be assessed or analyzed for risk assessment of developing toxicity after administration of cell therapy include one or more assays selected from IL-8, I1L-10 and CXCL10 . In some modalities, for any of the analyzed or biomarkers mentioned above, the individual is at risk of developing toxicity if the level,
[00426] [00426] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 30% or within 5% and it is within a standard deviation above the median or average level, quantity or concentration of IL-8, IL-10 or CXCL10 in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual in the group did not develop any toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor to treat the same disease or condition.
[00427] [00427] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 30% or within 5% and / or within a standard deviation below the median or average level , amount or concentration of IL-8, IL-10 or CXCL10 in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual in the group developed toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor to treat the same disease or condition.
[00428] [00428] In some respects, specimens or biomarkers or a volumetric measure of tumor burden that can be assessed or analyzed with respect to assessing the risk of developing toxicity after administration of cell therapy include one or more analyzed or volumetric measurements of tumor load selected from a sum of the products of diameters (SPD), LDH, Ferritin, C-reactive protein (PCR), D-dimer (fibrin degradation product), IL-6, IL-10, IL-15, IL-16 TNF-a, MIP-10a and MIP-
[00429] [00429] In some modalities, one or more analytical or volumetric measurements of the tumor load selected from LDH, SPD, IL-10, IL-15, I1L-15, IL-16, TNF-a and MIP-16B, and toxicity is neurotoxicity. In some modalities, one or more analytical or volumetric measurements of the tumor load selected from LDH, SPD, CRP, d-dimer, IL-6, IL-15, TNF-a and MIP-1a, and the toxicity is SLC. In some respects, elevated levels or measurements of LDH, SPD, IL-10, IL-15, IL-16, TNF-a and MIP-18, in a biological sample from an individual obtained prior to administration of cell therapy (pre treatment), may be associated with an increased risk of developing neurotoxicity (NT). In some respects, elevated levels or measurement of LDH, SPD, PCR, d-dimer, IL-6, 11-15, TNF-a and MIP-1a0, in a biological sample from an individual obtained prior to administration of cell therapy (pre-treatment), may be associated with an increased risk of developing a cytokine release syndrome (SLC).
[00430] [00430] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 32% or within 5% and / or within a standard deviation above the median or average level , amount or concentration of LDH, Ferritin, C-reactive protein (PCR), D-dimer (fibrin degradation product), IL-6, IL-10, IL-15, IL-16 TNF-a, MIP-10a or MIP -168 or the median or average volumetric measurement of the tumor load of a sum of the products of diameters (SPD), in a biological sample obtained from a group of individuals before receiving cell therapy, in which each of the individuals in the group did not develop toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00431] [00431] In some modalities, the threshold level is within 25%, within 20%, within 15%, within 32% or within 5% and / or within a standard deviation below the median or average level , amount or concentration of LDH, Ferritin, C-reactive protein (PCR), D-dimer (fibrin degradation product), IL-6, IL-10, IL-15, IL-16 TNF-a, MIP-10 or MIP -18 or the median or mean volumetric measure of tumor load of a sum of the products of diameters (SPD), in a biological sample obtained from a group of individuals before receiving cell therapy, in which each of the individuals in the group developed a toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00432] [00432] In some embodiments, the toxicity is neurotoxicity and the exemplary threshold level for LDH is equal to or greater than or greater than about 300 U / L, 400 U / L, 500 U / L or 600 U / L.
[00433] [00433] In some embodiments, the toxicity is neurotoxicity and the exemplary threshold level for SDP is equal to or greater than 30 cm , 40 cm , 50 cm , 60 cm , 70 cm , 80 cm or 90 cm .
[00434] [00434] In some embodiments, toxicity is neurotoxicity and the exemplary threshold level for IL-10 is greater than or equal to about 0.8 pg / ml, 0.9 pg / ml, 1 pg / ml, 2 pg / ml, 3 pg / ml or 4 Pg9 / ml.
[00435] [00435] In some embodiments, the toxicity is neurotoxicity and the exemplary threshold level for IL-15 is equal to or greater than 3 pgmL, 4 Pa / mL, 5 pg / mL, 6 pg / mL or 7 pg / mL.
[00436] [00436] In some embodiments, the toxicity is neurotoxicity and the exemplary threshold level for IL-16 is greater than or equal to about 600 pg / ml, 700 pg / ml, 800 pg / ml, 900 pg / ml or 1000 pa / ml.
[00437] [00437] In some embodiments, toxicity is neurotoxicity and the exemplary threshold level for TNF-a is 6 pg / mL, 7 pg / mL, 8 pg / mL, 9 pg / mL or 10 pg / mL.
[00438] [00438] In some embodiments, the toxicity is neurotoxicity and the exemplary threshold level for MIP-18 is equal to or greater than 70 pg / mL, 80 P9g / mL, 90 pg / mL or 100 pg / mL.
[00439] [00439] In some embodiments, the toxicity is SLC and an exemplary threshold level for LDH is equal to or greater than 300 U / L, 400 U / L, 500 U / L or 600 U / L.
[00440] [00440] In some modalities, the toxicity is SLC and the limit level for SDP is equal to or greater than 20 cm , 30 cm , 40 cm or 50 in .
[00441] [00441] In some embodiments, the toxicity is SLC and the exemplary threshold level for ferritin is equal to or greater than or greater than about 300 ng / mL, 400 ng / mL, 500 ng / mL, 600 ng / mL, 700 ng / ml, 800 ng / ml, 900 ng / ml or 1000 ng / ml.
[00442] [00442] In some embodiments, the toxicity is SLC and the exemplary threshold level for CRP is 20 mg / L, mg / L or 40 mg / L or more.
[00443] [00443] In some embodiments, the toxicity is SLC and the exemplary threshold level for the d-dimer is greater than or equal to about 300 pg / mL, 400 pg / mL, 500 pg / mL, 600 pg / mL , 700 pg / ml, 800 pg / ml, 900 pg / ml or 1000 pg / ml.
[00444] [00444] In some embodiments, the toxicity is SLC and the exemplary threshold level for IL-6 is equal to or greater than 2 pg / ml, 3 pg / ml, 4 pg / ml, 5 pg / ml, 6 pg / ml, 7 pg / ml, 8 pg / ml or 9 pg / ml.
[00445] [00445] In some embodiments, the toxicity is SLC and the exemplary threshold level for I | L-15 is equal to or greater than 3 pg / mL, 4 pg / mL, 5 pg / mL, 6 pg / mL, 7 pg / ml, 8 pg / ml, 9 pg / ml or 10 pg / ml.
[00446] [00446] In some embodiments, the toxicity is SLC and the exemplary threshold level for TNF-a is equal to or greater than 7 P9g / mL, 8 pg / mL, 9 pg / mL, 10 pg / mL or 15 pg / ml.
[00447] [00447] In some embodiments, the toxicity is SLC and the exemplary threshold level for MIP-1a is equal to or above or above or above about 20 pg / mL, 30 pg / mL or 40 pg / mL.
[00448] [00448] In some modalities, the biomarker is LDH and, in some cases, the development of toxicity, for example, SLC or NT, is correlated with the LDH value that is above a limit value. In some modalities, the inflammatory marker is LDH and the limit value is either about 300 units per liter, is or is about 400 units per liter, is or is about 500 units per liter, or is or is about 600 units per liter.
[00449] [00449] In some modalities, if the level, quantity or concentration of the biomarker (for example, analyzed) in the sample is equal to or higher than a threshold level of the analyzed, an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity is administered to the individual before, within one, two or three days after, simultaneously with and / or in the first fever after the initiation of administration of cell therapy to the individual. Exemplary agents or interventions for use in connection with the methods provided to treat, prevent, delay, reduce or mitigate the risk of developing toxicity are described in Section | l.
[00450] [00450] In some cases, if the level, the amount of concentration of the biomarker in the sample is equal to or above a threshold level, cell therapy is administered to the individual in a reduced dose or in a dose that is not associated with the risk of develop toxicity or severe toxicity or is not associated with a risk of developing severe toxicity or toxicity in most individuals and / or most individuals with a disease or condition that the individual has or is suspected to have after administration of cell therapy . In some cases, if the level, the amount of biomarker concentration in the sample is equal to or higher than a threshold level, cell therapy is administered to the individual in a hospital setting and / or with admission to the hospital for one or more days, optionally in which cell therapy should be administered otherwise to individuals on an outpatient basis or without admission to the hospital for one or more days.
[00451] [00451] In some modalities, if the level, quantity or concentration of the biomarker (for example, analyzed) is below a threshold level for the one analyzed, cell therapy is administered to the individual, optionally in a non-reduced dose. In some cases, cell therapy is optionally administered on an outpatient basis or without admission to the hospital for one or more days. In some modalities, if the level, quantity or concentration of the analyzed is below a threshold level, the administration of cell therapy does not include the administration, before or simultaneously with the administration of cell therapy and / or before the development of a symptom signal of toxicity other than fever, an agent or treatment capable of treating, preventing, delaying or mitigating the development of toxicity; and / or the administration of cell therapy must be or can be administered to the patient on an outpatient basis and / or without admission of the patient to the hospital overnight or for one or more consecutive days and / or without admission of the individual to the hospital for one or more more days.
[00452] [00452] In some aspects of the methods provided, it is determined that an individual is at risk of developing toxicity (for example, neurotoxicity, such as severe neurotoxicity or grade 3 or higher neurotoxicity, for example, grade 4 or 5 neurotoxicity and / or SLC, as severe SLC or SLC grade 3 or higher) by comparing the parameter (for example, concentration, quantity, level or activity) of the biomarker (for example, analyzed) or, individually, each of the biomarkers (for example, analyzed) with a reference value, as a threshold, of the corresponding parameter for the biomarker or for each biomarker. In some modalities, the comparison indicates whether or not the individual is at risk of developing toxicity, for example, neurotoxicity, such as severe neurotoxicity or grade 3 or higher neurotoxicity, and / or indicates grade 4 or 5 neurotoxicity and / or SLC, such as SLC serious or
[00453] [00453] In some embodiments, a parameter of a biomarker (for example, LDH, ferritin, CRP, IL-6, IL-8, I1L-10, TNF- a, IFN-a02, MCP-1 and MIP-18B) which is greater or greater than the reference value, for example threshold level, of the corresponding parameter is associated with a positive prediction of a toxicity risk (alone or in conjunction with the assessment of the other biomarkers in the panel). In some modalities, a parameter of a biomarker that is equal to or less than the reference value, for example, threshold level, of the corresponding parameter is associated with a negative prediction of a toxicity risk (alone or in conjunction with the evaluation of the other biomarkers on the panel).
[00454] [00454] In some modalities, the threshold level is determined based on the level, quantity, concentration or other measure of the biomarker (for example, analyzed) in the positive sample for the biomarker. In some respects, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% of the average level, quantity or concentration or measure and / or is within a standard deviation the mean level, quantity or concentration or measure, of the analyzed or parameter in a biological sample obtained from a group of individuals before receiving a therapeutic cell composition that expresses the recombinant receptor, in which each individual in the group developed a toxicity, for example, neurotoxicity such as severe neurotoxicity or grade 3 or higher neurotoxicity, for example, grade 4 or 5 neurotoxicity and / or SLC, such as severe SLC or grade 3 or higher SLC, after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00455] [00455] In some modalities of any of the methods provided, the biomarker (for example, analyzed) correlates and / or is predictive of the risk of developing severe neurotoxicity, such as severe neurotoxicity or neurotoxicity grade 3 or higher, for example, grade neurotoxicity 4 or 5 and / or severe SLC or SLC grade 3 or higher. In some embodiments, the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% of the average level, quantity or concentration or measure and / or is within a standard deviation the average level, quantity or concentration or measure, of the analyzed or parameter in a biological sample obtained from a group of individuals before receiving a therapeutic cell composition that expresses the recombinant receptor, in which each individual in the group started to develop neurotoxicity or severe grade 3 or more neurotoxicity, for example grade 4 or 5 neurotoxicity and / or severe SLC or grade 3 or higher SLC, after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00456] [00456] In some modalities, the volumetric measure is SDP and, in some cases, the development of toxicity, for example, SLC or NT, is correlated with the SDP value that is above a limit value. In some embodiments, the volumetric measure is SPD, and the threshold value is or is it about 30 cm , is it or is it about 40 cm , is it or is it about 50 cm , is it or is it about 60 cm or is it or is it about 70 cm . In some embodiments, the volumetric measure is SDP and the threshold value is or is it about 30 cm , is it or is it about 40 cm , is it or is it about 50 cm , is it or is it about 60 cm or is it or is it about 70 cm .
[00457] [00457] In some modalities, the parameter, including volumetric measurements of tumors, is associated with the response to cell therapy and / or a risk for the development of toxicity, for example, SLC or neurotoxicity (NT).
[00458] [00458] In some modalities, the volumetric measure is SDP and the threshold level is or is it about 30 cm , is it or is it about 40 cm , is it or is it about 50 cm , is it or is it about 60 cm or is it or is it about 70 cm . In some embodiments, the volumetric measurement is SDP and the threshold level is or is approximately 50 cm .
[00459] [00459] In some modalities, the analyzed is LDH and the threshold level is or is about 300 units per liter (U / L), is or is about 400 U / L, is or is about 500 U / L or is or is about 600 U / L. In some modalities, the analyzed is LDH and the threshold level is or is around 500 U / L.
[00460] [00460] In some modalities, the parameter or biomarker is LDH. In some modalities, the biomarker is LDH and the limit value is 500 U / L or higher. In some embodiments, the parameter or biomarker is SPD. In some modalities, the parameter is SDP and the threshold value is or is it around 50 cm or superior. In some modalities, the biomarker or parameters are SDP and LDH, and the limit values are SDP of 50 cm or higher and LDH of 500 U / L or higher. In some modalities, biomarkers or parameters are associated with an increased risk of developing SLC or NT.
[00461] [00461] In some modalities, a measurement of the parameter or marker that is above the limit value, for example, SDP of 50 cm or higher and LDH of 500 U / L or higher, is associated with an approximately 2-, 3-, 4-, 5-, 6-, 7-, 8, 9, 10 times higher risk of developing SLC or NT, as SLC or NT of any grade. In some modalities, a measurement of the parameter or marker that is below the limit value, for example, SDP less than 500 cm and LDH less than 500 U / L, is associated with approximately 2-, 3-, 4-, 5-, 6-, 7-, 8, 9, 10 times less risk of developing SLC or NT, such as SLC or NT of any degree.
[00462] [00462] In some embodiments, biomarkers (for example, analyzed) include those associated with increased cell pharmacokinetic parameters (PK), for example, increased maximum serum cell concentration (Cma) or increased exposure (eg, area under the curve (AUC)). In some embodiments, biomarkers (for example, analyzed), including their parameters, include IL-7, IL-15, MIP-1a and TNF-a.
[00463] [00463] In some modalities, the parameter is a parameter related to the tumor load, for example, a measurement of the tumor load. In some aspects, the methods also involve additional monitoring of the individual for possible toxicity symptoms based on the toxicity risk determined by assessing the presence or absence of the biomarker and / or comparing the biomarkers with a reference value or threshold level of the biomarker. .
[00464] [00464] In some embodiments, the methods and articles of manufacture provided may be used in connection with, or involve or include, one or more agents or treatments for the treatment, prevention, delay or mitigation of the development of a toxicity. In some examples, the agent or other treatment capable of treating, preventing, delaying or attenuating the development of a toxicity is administered before and / or simultaneously with the administration of a therapeutic cell composition comprising the genetically modified cells.
[00465] [00465] In some embodiments, the agent, for example, a toxicity targeting agent or treatment capable of treating, preventing, delaying or mitigating the development of a toxicity is a steroid, is an antagonist or inhibitor of a cytokine receptor, such as IL-6 receptor, CD122 receptor (IL-2Rbeta receptor) or CCR2, or is a cytokine inhibitor, such as | L-6, MCP-1, IL-10, IFN-y, IL-8 or IL-18. In some embodiments, the agent is an agonist of a cytokine and / or cytokine receptor, such as TGF-B. In some embodiments, the agent, for example, agonist, antagonist or inhibitor, is an antibody or antigen-binding fragment, a small molecule, a protein or peptide or a nucleic acid.
[00466] [00466] In some modalities, a fluid bolus can be used as an intervention, such as to treat hypotension associated with SLC. In some modalities, the target hematocrit levels are> 24%. In some modalities, the intervention includes the use of absorbent resin technology with blood or plasma filtration. In some cases, the intervention includes dialysis, plasmapheresis or similar technologies. In some modalities, vasopressors or acetaminophen may be used.
[00467] [00467] In some embodiments, the agent can be administered sequentially, intermittently or at the same time or in the same composition as therapy, as cells for adoptive cell therapy. For example, the agent can be administered before, during, simultaneously with or after administration of immunotherapy and / or cell therapy.
[00468] [00468] In some embodiments, the agent is administered at the same time as described here and according to the methods provided and / or the articles of manufacture or compositions provided. In some embodiments, the toxicity targeting agent is administered at a time that is within, such as less than or less than n, 3, 4, 5, 6, 7, 8, 9 or 10 days after the start of immunotherapy and / or cell therapy. In some embodiments, the toxicity targeting agent is administered within or within about 1 day, 2 days or 3 days after the start of administration of immunotherapy and / or cell therapy.
[00469] [00469] In some embodiments, the agent, for example, toxicity targeting agent, is administered to an individual after the start of administration of immunotherapy and / or cell therapy at a time when the individual does not exhibit SLC grade 2 or higher or neurotoxicity grade 2 or higher. In some respects, the toxicity targeting agent is administered after the start of administration of immunotherapy and / or cell therapy at a time when the individual does not exhibit severe SLC or severe neurotoxicity. Thus, between the start of administration of immunotherapy and / or cell therapy and the toxicity targeting agent, the individual is one who does not exhibit SLC grade 2 or higher, such as severe SLC, and / or does not exhibit grade 2 or higher neurotoxicity, as severe neurotoxicity.
[00470] [00470] Non-limiting examples of interventions for treating or ameliorating a toxicity, such as severe SLC (SLCg), are described in Table 5. In some modalities, the intervention includes tocilizumab or another toxicity targeting agent, as described, which may be at a time when there is prolonged or persistent fever greater than or equal to 38 ºC or greater or greater than about 39 “ºC in the individual. In some modalities, the fever is maintained in the individual for more than 10 hours, more than 12 hours, more than 16 hours or more than 24 hours before the intervention.
[00471] [00471] In some cases, the agent or therapy or intervention, for example, toxicity targeting agent, is administered alone or is administered as part of a composition or formulation, as a pharmaceutical composition or formulation, as described here. Thus, the agent alone or as part of a pharmaceutical composition can be administered intravenously or orally, or by any other known acceptable route of administration or as described herein.
[00472] [00472] In some embodiments, the dosage of the agent or the frequency of administration of the agent in a dosage regimen is reduced compared to the dosage of the agent or its frequency in a method in which an individual is treated with the agent after the degree 2 or SLC or greater or greater neurotoxicity, such as after severe neurotoxicity, for example, grade 3 or higher, or after severe neurotoxicity, for example, grade 3 or higher, has been developed or diagnosed (for example, after physical signs or symptoms of SLC grade 3 or higher or manifest neurotoxicity). In some embodiments, the dosage of the agent or the frequency of administration of the agent in a dosage regimen is reduced compared to the dosage of the agent or its frequency in a method in which an individual is treated for SLC or neurotoxicity greater than 3 days, 4 days, 5 days, 6 days, 1 week, 2 weeks, three weeks or more after administration of immunotherapy and / or cell therapy. In some embodiments, the dosage is reduced by more or more than 1.2 times, 1.5 times, 2 times, 3 times, 4 times, 5 times, 6 times, 7 times, 8 times, 9 times, 10 times or more. In some embodiments, the dosage is reduced by more than or about 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or more. In some embodiments, the frequency of dosing is reduced, as the number of daily doses is reduced or the number of dosing days is reduced. A. Steroid
[00473] [00473] In some modalities, the agent, for example, toxicity targeting agent, which treats and / or prevents, delays or mitigates the development or risk of developing toxicity for an immunotherapy and / or cell therapy, is a steroid, for example, corticosteroid. Corticosteroids usually include glucocorticoids and mineralocorticoids.
[00474] [00474] Any corticosteroid, for example, glucocorticoid, can be used in the methods provided here. In some embodiments, glucocorticoids include synthetic and non-synthetic glucocorticoids. Examples of glucocorticoids include, but are not limited to: alclomethasones, - algestones, - beclomethasones (eg, beclomethasone dipropionate), betamethasone (eg, betamethasone 17-valerate, betamethasone acetate, betamethasone sodium phosphate, betamethasone valerate ), budesonides, clobetasetas (clobetasonas), clobetasonas, clocortolones (for example, clocortolone pivalate), cloprednoles, corticosterones, cortisonas and hydrocortisonas (for example, hydrocortisone acetate), cortivazoles, deflazacorts, for example, deoximethasone 21-dexamethasone phosphate, dexamethasone acetate, sodium dexamethasone phosphate), diflorasones (for example, diflorasone diacetate), diflucortolones, difluprednates, —oxoxones, fluazacorts, fluclorides, fludrocortones (for example, fludrocortones (for example, fludrocortones) flumetasone pivalate), flunisolides, fluocinolones (eg fluocinolone acetamide), fluperolones (for example, fluperolone acetate), fluprednidenes, fluprednisolones, - flurandrenolides, fluticasones (for example, fluticasone propionate), formocortals, halcinonides, halobetasols, halometasones, halopredones, hydrocortates, hydrocortisones (for example, 21-butyrate hydrocortate, hydrocortisone hydrochloride hydrocortisone, hydrocortisone acetate, hydrocortisone probitate, hydrocortisone, hydrocortisone, hydrocortisone, hydrocortisone, hydrocortisone, sodium succinate, hydrocortisone valerate), batchprednone etherprone, methionpredonee, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone, methionpredone methylprednisolone, methylprednisolone hemisuccinate, methylprednisolone sodium succinate), mometasones (eg mometasone furuate), .paramethasones (eg parametasone acetate) m prednicarbates, prednisolones (eg, 25-diethylamine prednisolone prednisolone phosphate prednisolone) , 21- pre hemisuccinate dnisolone, prednisolone acetate; prednisolone farnesylate, prednisolone hemisuccinate, prednisolone-21 (beta-D-glucuronide), prednisolone methasulfobenzoate, prednisolone tebutate, prednisolone tetrahydrophthalate, prednisone, prednisolone, prednisolone, prednisolone, prednisone for example, triamcinolone acetonide, triamcinolone benetonide, triamcinolone hexacetonide, triamcinolone 21-palmitate acetonide, triamcinolone diacetate). These glucocorticoids and their salts are discussed in detail, for example, in Remington's Pharmaceutical Sciences, A. Osol, ed., Mack Pub. Co., Easton, Pa. (16th ed. 1980).
[00475] [00475] In some examples, glucocorticoid is selected from among cortisone, = dexamethasone, hydrocortisone, - methylprednisolones,
[00476] [00476] In some embodiments, the agent is a corticosteroid and is administered in a therapeutically effective amount to treat, ameliorate or reduce one or more symptoms of a toxicity for an immunotherapy and / or cell therapy, such as SLC or neurotoxicity. In some modalities, indicators of improvement or successful treatment include determining failure to manifest a relevant score on the toxicity rating scale (for example, SLC or neurotoxicity rating scale), such as a score of less than 3 or a change in rating or severity on the rating scale discussed here, such as a change from a score of 4 to a score of 3 or a change from a score of 4 to a score of 2, 1 or O.
[00477] [00477] In some respects, corticosteroids are provided in a therapeutically effective dose. The therapeutically effective concentration can be determined empirically by testing on known systems in vitro or in vivo (eg, animal model). For example, the amount of a selected corticosteroid to be administered to ameliorate the symptoms or adverse effects of a toxicity for immunotherapy and / or cell therapy, such as SLC or neurotoxicity, can be determined by standard clinical techniques. In addition, animal models can be used to help identify optimal dosage ranges. The precise dosage, which can be determined empirically, may depend on the specific therapeutic preparation, the dosage regimen and scheme, the route of administration and the severity of the disease.
[00478] [00478] The corticosteroid can be administered in any amount that is effective to improve one or more symptoms associated with toxicity, such as SLC or neurotoxicity. The corticosteroid, for example, glucocorticoid, can be administered, for example, in an amount between 0.1 and 100 mg or about 0.1 mg per dose, 0.1 to 80 mg, 0.1 to 60 mg, 0 , 1 to 40 mg, 0.1 to 30 mg, 0.1 to 20 mg, 0.1 to 15 mg, 0.1 to 10 mg, 0.1 to 5 mg, 0.2 to 40 mg, 0, 2 to mg, 0.2 to 20 mg, 0.2 to 15 mg, 0.2 to 10 mg, 0.2 to 5 mg, 0.4 to 40 mg, 0.4 to 30 mg, 0.4 to 20 mg, 0.4 to 15 mg, 0.4 to 10 mg, 0.4 to 5 mg, 0.4 to 4 mg, 1 to 20 mg, 1 to 15 mg or 1 to 10 mg, to a human subject 70 kg adult. Typically, the corticosteroid, like a glucocorticoid, is administered in an amount between 0.4 and 20 mg, or approximately, for example, 0.4 mg, 0.5 mg, 0.6 mg, 0.6 mg, 0, 7 mg, 0.75 mg, 0.75 mg, 0.8 mg, 0.9 mg 1 mg, 2 ma, 3 mg, 4 mg, 5 mg, 6 mg, 7 mg, 8 mg, 9 mg, 10 mg, 11 mg, 12 mg, 13 mg, 14 mg, 14 mg, 15 mg, 16 mg, 17 mg, 18 mg, 19 mg or 20 mg per dose to an average adult human individual.
[00479] [00479] In some embodiments, the corticosteroid can be administered, for example, in a dosage of approximately 0.001 mg / kg (from the individual), 0.002 mg / kg, 0.003 mg / kg, 0.004 mg / kg, 0.005 mg / kg, 0.006 mg / kg, 0.007 mg / kg, 0.008 mg / kg, 0.009 mg / kg, 0.01 mg / kg, 0.015 mg / kg, 0.02 mg / kg, 0.025 mg / kg, 0.03 mg / kg , 0.035 mg / kg, 0.04 mg / kg, 0.045 mg / kg, 0.05 mg / kg, 0.055 mg / kg, 0.06 mg / kg, 0.065 mg / kg, 0.07 mg / kg, 0.075 mg / kg, 0.08 mg / kg, 0.085 mg / kg, 0.09 mg / kg, 0.095 mg / kg, 0.1 mg / kg, 0.15 mg / kg, 0.2 mg / kg, 0 , 25 mg / kg, 0.380 mg / kg, 0.35 mg / Kkg, 0.40 mg / kg, 0.45 mg / kg, 0.50 mg / kg, 0.55 mg / kg, 0.60 mg / kg, 0.65 mg / kg, 0.70 mg / kg, 0.75 mg / kg, 0.80 mg / kg, 0.85 mg / kg, 0.90 mg / kg, 0.95 mg / kg, 1 mg / kg, 1.05 mg / kg, 1.1 mg / kg, 1.45 mg / kg, 1.20 mg / kg, 1.25 mg / kg, 1.3 mg / kg, 1 , 35 mg / kg or 14 mg / kg, to an average adult human individual, typically weighing about 70 kg to 75 kg.
[00480] [00480] Corticosteroid or glucocorticoid, for example,
[00481] [00481] In some respects, glucocorticoid can be administered over a period of more than one day, such as more than two days, more than 3 days or more than 4 or more days. In some modalities, corticosteroids can be administered once a day, twice a day, or three times or more a day. For example, corticosteroids, for example, dexamethasone, may in some instances be administered 10 mg (or equivalent) of IV twice daily for three days.
[00482] [00482] In some modalities, the dosage of corticosteroids, for example, glucocorticoids, is administered in successively lower doses per treatment. Therefore, in some of these treatment regimens, the dose of corticosteroids is reduced. For example, the corticosteroid can be administered in an initial dose (or equivalent dose, as with reference to dexamethasone) of 4 mg and, after each successive administration, the dose can be reduced, so that the dose is 3 mg for the next administration, 2 mg for the next administration and 1 mg for the next administration
[00483] [00483] Generally, the corticosteroid administered depends on the specific corticosteroid, as there is a difference in potency between the different corticosteroids. It is typically understood that drugs vary in potency and therefore doses can vary in order to obtain equivalent effects. Table 6 shows the equivalence in terms of potency for various glucocorticoids and routes of administration. The equivalent potency in clinical dosing is well known. Information related to the equivalent dosage of steroids (non-chronotherapeutic) can be found in the British National Formulary (BNF) 37, March 1999. Table 6: Administration of glucocorticoid Glycorticoid (Routine)
[00484] [00484] Thus, in some modalities, the steroid is administered in an equivalent dosage amount of about 1.0 mg to 20 mg dexamethasone per day, such as 1.0 mg to 15 mg dexamethasone per day, 1.0 mg to 10 mg dexamethasone daily, 2.0 mg to 8 mg dexamethasone daily or 2.0 mg to 6.0 mg dexamethasone daily, each inclusive. In some cases, the steroid is administered in an equivalent dose of approximately 4 mg or approximately 8 mg of dexamethasone per day.
[00485] [00485] In some modalities, the steroid is administered if the fever persists after treatment with tocilizumab. For example, in some modalities, dexamethasone is administered orally or intravenously in a dosage of 5-10 mg until every 6-12 hours with continuous fevers. In some modalities, tocilizumab is administered simultaneously or after oxygen supplementation. B. Microglial Cell Inhibitor
[00486] [00486] In some embodiments, the inhibitor in combination therapy is an inhibitor of microglial cell activity. In some embodiments, the administration of the inhibitor modulates the activity of the microglia. In some embodiments, the inhibitor is an antagonist that inhibits the activity of a signaling pathway in the microglia. In some embodiments, the microglia inhibitor affects microglial homeostasis, survival and / or proliferation. In some embodiments, the inhibitor targets the CSFIR signaling pathway. In some embodiments, the inhibitor is a CSFIR inhibitor. In some embodiments, the inhibitor is a small molecule. In some cases, the inhibitor is an antibody.
[00487] [00487] In some respects, administration of the inhibitor results in one or more effects selected from a change in microglial homeostasis and viability, a decrease or blockage of microglial cell proliferation, a reduction or elimination of microglial cells, a reduction in activation microglial, a reduction in the production of nitric oxide from the microglia, a reduction in the activity of nitric oxide synthase in the microglia or protection of motor neurons affected by microglial activation. In some embodiments, the agent alters the level of a serum or blood biomarker for CSF1IR inhibition or a decrease in the level of cross-linked type 1 urinary collagen (NTX) N-telopeptide compared to a time just before the inhibitor is started. In some - modalities, the administration of the agent transiently inhibits the activity of the microglia activity and / or in which the inhibition of the microglia activity is not permanent. In some embodiments, administration of the agent transiently inhibits CSFIR activity and / or in which the inhibition of CSFIR activity is not permanent.
[00488] [00488] In some embodiments, the agent that reduces the activity of microglial cells is a small molecule, peptide, protein, antibody or antigen-binding fragment, a mimetic antibody, an aptamer or a nucleic acid molecule. In some embodiments, the method involves the administration of an inhibitor of microglia activity. In some embodiments, the agent is an antagonist that inhibits the activity of a signaling pathway in the microglia. In some embodiments, the agent that reduces microglial cell activity affects homeostasis, survival and / or microglial proliferation.
[00489] [00489] In some embodiments, the agent that reduces microglial cell activation is selected from an anti-inflammatory agent, a NADPH oxidase inhibitor (NOX2), a calcium channel blocker, sodium channel blocker, inhibits GM-CSF, inhibits CSFI1R, specifically binds to CSF-1, specifically binds to I1L-34, inhibits activation of nuclear factor cover B (NF-KB), activates a CB2 receptor and / or is an agonist of the CB2, a phosphodiesterase inhibitor, inhibits microRNA-155 (miR-155), up-regulates microRNA-124 (miR-124), inhibits the production of nitric oxide in the microglia, inhibits nitric oxide synthase or activates the transcription factor NRF2 (also called nuclear factor (derived from erythroid 2) type 2 or NFE2L2).
[00490] [00490] In some embodiments, the agent that reduces the activity of microglial cells targets CSF1 (also called MCSF macrophage colony stimulating factor). In some embodiments, the agent that reduces microglial cell activity affects MCSF-stimulated phosphorylation of the M-CSF receptor (Pryer et al. Proc Am Assoc. Cancer Res, AACR Abstract nr DDTO02-2 (2009)). In some cases, the agent that reduces the activity of microglial cells is MCS110 (publication number of the international patent application WO2014001802; Clinical Trial Study Record Nos .: A1 NCTOO0757757; NCTO2807844; NCTO2435680; NCTO1643850).
[00491] [00491] In some embodiments, the agent that reduces the activity of microglial cells is a small molecule that directs the CSF1 pathway. In some embodiments, the agent is a small molecule that binds to CSFIR. In some embodiments, the agent is a small molecule that inhibits CSF1IR kinase activity by competing with ATP binding to CSF1IR kinase. In some embodiments, the agent is a small molecule that inhibits the activation of the CFS1IR receptor. In some cases, the binding of the CSF-1 linker to the CSFIR is inhibited. In some embodiments, the agent that reduces the activity of microglial cells is any of the inhibitors described in the U.S. patent application publication number US20160032248.
[00492] [00492] In some embodiments, the agent is a small molecule inhibitor selected from PLX-3397, PLX7486, JNJ- 40346527, JNJ28312141, ARRY-382, PLX73086 (AC-708), DCC- 3014, AZD6495, GW2580, Ki20227, BLZ945, PLX647, PLX5622. In some embodiments, the agent is any of the inhibitors described in Conway et al., Proc Natl Acad Sci USA, 102 (44): 16078-83 (2005); Dagher et al., Journal of Neuroinflammation, 12: 139 (2015); Ohno et al., Mol Cancer Ther. 5 (11): 2634-43 (2006); von Tresckow et al. Clin Cancer Res., 21 (8) (2015); Manthey et al. Mol Cancer Ther. (8 (11): 3151-61 (2009); Pyonteck et al., Nat Med. 19 (10): 1264-1272 (2013); Haegel et al., Cancer Res AACR Abstract nr 288 (2015); Smith et a /. al., Cancer Res AACR Abstract nr 4889 (2016); Clinical Trial Study Record Nos: NCTO1525602; NCTO02734433; NCTO2777710; NCTO1804530; NCTO1597739; NCTO1572519; NCTO1054014; NCTO1316822; international publication: NCTO1316722; international publication: NW; patent application publication US20110044998, US 2014/0065141 and US 2015/0119267.
[00493] [00493] In some embodiments, the agent that reduces the activity of microglial cells is 4 - ((2 - (((1R, 2R) -2-hydroxycyclohexyl) amino) benzo [dltiazol-6-yl) Oxy) - N-methylpicolinamide (BLZ945) or its pharmaceutically acceptable salt or its derivatives. In some embodiments, the agent is the following compound:
[00494] [00494] In some embodiments, the agent that reduces microglial cell activity is 5 - ((5-chloro-1H-pyrrolo [2,3-b] pyridin-3-yl) methyl) - N - ((6- (trifluoromethyl) pyridin-3-yl) methyl) pyridin-2-amine, N- [5 - [(5-Chloro-1H-pyrrolo [2,3-b] pyridin-3-yl) methyl] -2-pyridinyl ] -6- (trifluoromethyl!) - 3-pyridinemethanamine) (PLX 3397) or its pharmaceutically acceptable salt or its derivatives. In some embodiments, the agent is 5- (1H-pyrrolo [2,3-b] pyridin-3-ylmethyl) -N - [[4- (triluoromethyl) phenyl] Jmetyl] -2-pyridinamine dihydrochloride - (PLX647 ) or its pharmaceutically acceptable salt or derivatives. In some embodiments, the agent that reduces the activity of microglial cells is the following compound: AO (IS -
[00495] [00495] In some embodiments, the agent that reduces microglial cell activity is 4-cyano-N- [2- (1-cyclohexen-1-yl) -4- [1 - [(dimethylamino) acetyl] hydrochloride ] -4-piperidinyl] phenyl] -1H-imidazo | -2-carboxamide (JNJ28312141) or its pharmaceutically acceptable salt or derivatives. In some embodiments, the agent is the following compound: 8 Ae TE Nes
[00496] [00496] In some embodiments, the agent that reduces microglial cell activity is 1H-Imidazole-2-carboxamide, S5-cyano-N- (2- (4, 4-dimethyl-1-cyclohexen-1-yl ) -6- (tetrahydro-2,2,6,6-tetramethyl-2H-pyran-4-yl1) -3-pyridinyl) -, N- (2- (4,4-dimethylcyclohex-1- enyl) -6- (2,2,6,6- tetramethyltetrahydropyran-4-yl) pyridin-3-yl) 4-cyano-1H-imidazole-2-carboxylic acid amide, - 4-cyano-N- (2- (4,4-dimethylcyclohex-1-en-1-i1) -6- (2,2,6,6-tetramethyl-tetrahydro-2H-pyran-4-yl) pyridin-3- il) -1H-imidazole-2-carboxamide (JNJ-40346527) or its pharmaceutically acceptable salt or derivatives. In some embodiments, the agent is the following compound: =, or its pharmaceutically acceptable salt.
[00497] [00497] In another embodiment, the agent that reduces the activity of microglial cells is 5- (3-methoxy-4 - ((4-methoxybenzyl) oxy) benzyl) pyrimidine-2,4-diamine (GW2580) or a pharmaceutically salt acceptable value of the product or its derivatives. In some embodiments, the agent is the following compound: NH, so E "Tl He" It is CH, or a pharmaceutically acceptable salt thereof (publication number of international patent application WO2009099553).
[00498] [00498] In some embodiments, the agent that reduces microglial cell activity is 4- (2,4-difluoroanilino) -7-ethoxy-6- (4-methylpiperazin-1-yl) quinoline-3-carboxamide (AZD6495) or its pharmaceutically acceptable salt or derivatives. In some modalities, the agent is the following compound: Fesd nº à N o N O.
[00499] [00499] In some embodiments, the agent that reduces microglialis cell activity is NX4- (6,7-dimethoxy-4-quinolyl) oxyl-2-methoxyphenyl) -NO0- [1- (1,3-thiazol-2 -il) ethylJureia (Ki20227) or its pharmaceutically acceptable salt! or its derivatives. In some embodiments, the agent is the following compound:
[00500] [00500] In some embodiments, the agent that reduces the activation of microglial cells is an antibody that directs the CSF1 pathway. In some embodiments, the agent is an antibody that binds to CSF1IR. In some embodiments, the anticOSFIR antibody blocks CSFIR dimerization. In some embodiments, the anti-CSF1R antibody blocks the CSFIR dimerization interface that is formed by the D4 and D5 domains (Ries et al. Cancer Cell 25 (6): 846-59 (2014)). In some cases, the agent is selected from emactuzumab (RG7155; ROS509554), cabiralizumab (FPA-O08), LY-3022855 (IMC-CS4), AMG-820, TG-3003, MCS110, H27K15, 12-2D6, 2- 4A5 (Rovida and Sbarba, J Clin Cell Immunol.6: 6 (2015); Clinical Trial Study Nos .: Record NCT02760797; NCTO1494688; NCTO2323191; NCTO1962337; NCTO02471716; NCTO2526017; NCTO1346358 ,; NCTO02265536; NCTO02265536; NCT02265536; NOCT02265536; NCTO1643850) .
[00501] [00501] In some embodiments, the agent that reduces microglial cell activation is a tetracycline antibiotic. For example, the agent affects the concentration of IL-1b, IL-6, TNF-a or iNOS in microglia cells (Yrjânheikki et al. PNAS 95 (26): 15769-15774 (1998); Clinical Trial Study Record No: NCTO01120899) In some embodiments, the agent is an opioid antagonist (Younger et al. Pain Med. 10 (4): 663-672 (2009.) In some embodiments, the agent reduces glutamatergic neurotransmission (US Patent Number
[00502] [00502] It is believed that the production of nitric oxide from microglia, in some cases, results in or increases neurotoxicity. In some embodiments, the agent modulates or inhibits the production of nitric oxide from the microglia. In some embodiments, the agent inhibits nitric oxide synthase (NOS). In some embodiments, the NOS inhibitor is Ronopterin (VAS-203), also known as 4-amino-tetrahydrobiopterin (4-ABH4). In some embodiments, the NOS inhibitor is cindunistate, A-84643, ONO-1714, L-NOARG, NCX-456, VAS-2381, GW-273629, NXN-462, CKD-712, KD-7040 or guanidinoethyldisulfide. In some embodiments, the agent is any of the inhibitors described in Hôing et a /., Cell Stem Cell. November 2, 2012; 11 (5): 620-32.
[00503] [00503] In some embodiments, the agent blocks T cell traffic, as in the central nervous system. In some embodiments, blocking T-cell trafficking can reduce or prevent immune cells from crossing blood vessel walls in the central nervous system, including the crossing of the blood-brain barrier. In some cases, T cells specific for the activated antigen produce pro-inflammatory cytokines, including IFN-y and TNF, after reactivation in the CNS, leading to the activation of resident cells, such as microglia and astrocytes. See Kivisákk et a /., Neurology. 2009 June 2; 72 (22): 1922-1930. Thus, in some modalities, hijacking activated T cells from microglial cells, such as blocking traffic and / or inhibiting the ability of these cells to cross the blood-brain barrier, can reduce or eliminate microglial activation. In some embodiments, the agent inhibits adhesion molecules on immune cells, including T cells. In some embodiments, the agent inhibits an integrin. In some embodiments, the integrin is alpha-4 integrin. In some modalities, the agent is natalizumab (Tysabri &). In some embodiments, the agent modulates a cell surface receptor. In some embodiments, the agent modulates the sphingosine-1-phosphate receptor (SIP), such as SIPR1 or SIPR5. In some embodiments, the agent causes the internalization of a cell receptor, such as a sphingosine-1-phosphate (SIP) receptor, such as SIPR1 or S1PR5. In some embodiments, the agent is fingolimod (Gilenya € O) or ozanimod (RPC-1063).
[00504] [00504] The NRF2 transcription factor is thought to regulate the antioxidant response, for example, by activating genes that contain a cis-acting element in their promoter region. An example of such an element includes an antioxidant response element (ARE). In some embodiments, the agent activates NRF2. In some embodiments, the activation of NRF2 in microglial cells reduces the responsiveness of microglial cells to IFN and LPS. In some embodiments, the activation of NRF2 inhibits, decreases or reduces demyelination, axonal loss, neuronal death and / or death of oligodendrocytes. In some embodiments, the agent regulates positively the cell cytoprotective pathway regulated by NRF2. In some embodiments, the agent that activates NRF2 is dimethyl fumarate (Tecfidera &). In some embodiments, the agent is any of the inhibitors described in US patent number 8,399,514. In some embodiments, the agent is any of the inhibitors described in Hôing et al., Cell Stem Cell. November 2, 2012; 11 (5): 620-32.
[00505] [00505] In some embodiments, the agent that reduces microglial cell activation is (48.4aS, 5aR, 12aS) -4,7-bis (dimethylamino) - 3,10,12,12a-tetrahydroxy-1, 11-dioxo-1,4,4a, 5,5a9, 6,11,12a-octa-
[00506] [00506] In some embodiments, the agent that reduces microglial cell activation is 3- (7-amino-3-0x0-1H-isoindol-2-yl) piperidine-2,6-dione (lenalidomide) or a pharmaceutically salt acceptable value of the product or its derivatives. In some embodiments, the agent is the following compound: O
[00507] [00507] In some embodiments, the agent that reduces microglial cell activation is 4R, 4aS, 7aR, 12bS) -4a, 9-dihydroxy-3-prop-2-enyl-2,4,5,6, 7a, 13-hexahydro-1H-4,12-methanobenzofuro [3,2-elisoquinoline-7-one (naloxone) or its pharmaceutically acceptable salt or derivatives. In some embodiments, the agent is any of the compounds described in US patent number US8247425. In some embodiments, the agent is the following compound:
[00508] [00508] In some embodiments, the agent that reduces microglial cell activation is 2-amino-6- (trifluoromethoxy) benzothiazole, 6- (triluoromethoxy) benzo [d] thiazol-2-amine or G6- (trifluoromethoxy) -1 , 3-benzothiazole-2-amine (riluzole) or its pharmaceutically acceptable salt or its derivatives, as described in US patent number US5527814. In some embodiments, the agent is the following compound:
[00509] [00509] In some embodiments, the agent that reduces the activation of microglial cells is a modulator of a signaling pathway in the microglia. In some cases, the agent reduces microglia selection. In some embodiments, the agent is a GM-CSF (CSF2) inhibitor. In other embodiments, the agent that reduces the activation of microglial cells is an ion channel blocker. In some specific embodiments, the agent is a calcium channel blocker. For example, in some specific examples, the agent is a calcium channel blocker for dihydropyridine. In some embodiments, the agent is a microRNA inhibitor. For example, the agent targets miR-155. In some embodiments, the agent that reduces microglial cell activation is selected from MOR103, Nimodipine, IVig and LNA-anti-miR-155 (Butoxsky et al. Ann Neurol., 77
[00510] [00510] In some embodiments, the agent that reduces microglial cell activation is 3- (2-methoxyethyl) 5-propan-2-yl 2,6-dimethyl-4- (3-nitrophenyl) -1,4-di -hydropyridine-3,5-dicarboxylate (nimodipine) or its pharmaceutically acceptable salt! or its derivatives. In some embodiments, the agent is one of the inhibitors described in US patent number US3799934. In some embodiments, the agent is the following compound: 2 to Ne o> o AAA
[00511] [00511] In some cases, the agent that reduces microglial cell activation is administered in a way that affects only the central nervous system and / or does not affect macrophages associated with the tumor. In some embodiments, the agent promotes the quiescence of the microglia, but does not eliminate or reduce the number of microglia. In some embodiments, the method involves inhibiting microglia activity specifically in the brain, as described in Ponomarev et al., Nature Medicine, (1): 64-70 (2011)
[00512] [00512] Exemplary agents that reduce microglial cell activation and exemplary dosing schedules for administering such agents are shown in Table 7 below.
[00513] [00513] In some modalities, the agent, for example, toxicity targeting agent, which treats or improves the symptoms of an immunotherapy toxicity and / or a cellular therapy, such as SLC or neurotoxicity, is the one that directs a cytokine, for example, is a cytokine antagonist or inhibitor, such as the transformation of growth factor beta (TGF-beta), interleukin 6 (IL-6), interleukin 10 (IL-10), IL-2, MIPIB (CCL4), Alpha TNF, IL-1, interferon 'gamma (IFN-gamma) or monocyte chemoattracting protein-11 (MCP-1). In some embodiments, the agent that treats or improves the symptoms of an immunotherapy and / or cell therapy toxicity, such as SLC or neurotoxicity, is the agent that targets (for example, inhibits or is an antagonist) a cytokine receptor, as an IL-6 receptor (IL-6R), IL-2 receptor (Il-2R / CD25), MCP-1 receptor (CCL2) (CCR2 or CCRA4), a TGF-beta receptor (TGF-beta | , Il or Ill), IFN-gamma receptor (IFNGR),
[00514] [00514] The amount of a selected agent that treats or improves the symptoms of an immunotherapy toxicity and / or a cell therapy, such as SLC or neurotoxicity to be administered to improve symptoms or adverse effects of an immunotherapy toxicity and / or cell therapy, such as SLC or neurotoxicity, can be determined by standard clinical techniques. Exemplary adverse events include, among others, an increase in alanine aminotransferase, an increase in aspartate aminotransferase, chills, febrile neutropenia, headache, hypotension, left ventricular dysfunction, encephalopathy, hydrocephalus, seizure and / or tremor.
[00515] [00515] In some embodiments, the agent is administered in a dosage amount of or about 30 mg to 5000 mg, such as 50 mg to 1000 mg, 50 mg to 500 mg, 50 mg to 500 mg, 50 mg to 200 mg, 50 mg to 100 mg, 100 mg to 1000 mg, 100 mg to 500 mg, 100 mg to 200 mg, 200 mg to 1000 mg, 200 mg to 500 mg or 500 mg to 1000 mg.
[00516] [00516] In some embodiments, the agent is administered at or from about 0.5 mg / kg to 100 mg / kg, as from or about 1 mg / kg to 50 mg / kg, 1 mg / kg to 25 mg / kg, 1 mg / kg to 10 mg / kg, 1 mg / kg to 5 mg / kg, 5 mg / kg to 100 mg / kg, 5 mg / kg to 50 mg / kg, 5 mg / kg to 25 mg / kg, mg / kg to 10 mg / kg, 10 mg / kg to 100 mg / kg, 10 mg / kg to 50 mg / kg, 10 mg / kg to 25 mg / kg, 25 mg / kg to 100 mg / kg, 25 mg / kg to 50 mg / kg to 50 mg / kg to 100 mg / kg. In some embodiments, the agent is administered in a dosage amount of or about 1 mg / kg to 10 mg / kg, 2 mg / kg to 8 mg / kg, 2 mg / kg to 6 mg / kg, 2 mg / kg to 4 mg / kg or 6 mg / kg to 8 mg / kg, each inclusive. In some aspects, the agent is administered in a dosage amount of at least or at least about 1 mg / kg, 2 mg / kg, 4 mg / kg, 6 mg / kg, 8 mg / kg, 10 mg / kg or more. In some embodiments, the agent is administered at a dose of 4 mg / kg or 8 mg / kg.
[00517] [00517] In some modalities, the agent is administered by injection, for example, intravenous or subcutaneous injections, intraocular injection, periocular injection, subretinal injection, intravitreal injection, transseptal injection, subscleral injection, intracoroidal injection, intracameral injection, subconjectal injection , subconjunctival injection, sub-Tenon injection, retrobulbar injection, peribulbar injection or posterior juxescleral release In some modalities, they are administered by parenteral, intrapulmonary and intranasal administration and, if desired for local treatment, intralesional administration. Parenteral infusions include intramuscular, - intravenous, intraarterial, intraperitoneal! - or subcutaneous administration.
[00518] [00518] In some modalities, the amount of the agent is administered approximately or approximately twice a day, daily, every other day, three times a week, weekly, every two weeks or once a month.
[00519] [00519] In some embodiments, the agent is administered as part of a composition or formulation, as a pharmaceutical composition or formulation, as described below. Thus, in some cases, the composition comprising the agent is administered as described below. In other respects, the agent is administered alone and can be administered by any acceptable route of administration known or by one described herein, such as in relation to pharmaceutical compositions and formulations.
[00520] [00520] In some embodiments, the agent that treats or ameliorates the symptoms of immunotherapy and / or cell therapy toxicity, such as SLC or neurotoxicity, is an antibody or antigen-binding fragment. In some embodiments, the agent is tocilizumab, siltuximab, sarilumab, olokizumab (CDP6038), elsilimomab, ALD518 / BMS-945429, sirukumab (CNTO 136), CPSI-2634, ARGX-109, FE301 or FM101.
[00521] [00521] In some embodiments, the agent is an antagonist or inhibitor of IL-6 or IL-6 receptor (IL-G6R). In some respects, the agent is an antibody that neutralizes IL-6 activity, such as an antibody or antigen-binding fragment that binds to IL-6 or IL-6R. For example, in some embodiments, the agent is or comprises tocilizumab (atlizumab) or sarilumab, anti-IL-6R antibodies. In some embodiments, the agent is an anti-IL-6R antibody described in U.S. Patent No. 8,562,991. In some cases, the agent that targets IL-6 is an anti-IL-6 antibody, such as siltuximab, elsiimomab, ALD518 / BMS-945429, sirukumab (CNTO 136), CPSI-2634, ARGX-109, FE301, FM101, or olokizumab (CDP6038). In some ways, the agent can neutralize IL-6 activity by inhibiting ligand-receptor interactions. The viability of this general type of approach has been demonstrated with a natural interleukin-1 receptor antagonist. See, Harmurn, C.H. et a /., Nature (1990) 343: 336-
[00522] [00522] In some modalities, the agent is tocilizumab. In some embodiments, tocilizumab is administered as an early intervention according to the methods provided and / or the articles of manufacture or compositions provided, in a dosage of or from about 1 mg / kg to 12 mg / kg, such as approximately 4 mg / kg, 8 mg / kg or 10 mg / kg. In some modalities, tocilizumab is administered by intravenous infusion. In some modalities, tocilizumab is given for a persistent fever greater than 39 “C, lasting 10 hours, which does not respond to acetaminophen. In some modalities, a second administration of tocilizumab is provided if symptoms persist after 48 hours of the initial dose.
[00523] [00523] In some embodiments, the agent is a TGF-B agonist or stimulator or a TGF-B receptor (e.g., TGF-B receptor |, Il or Ill). In some ways, the agent is an antibody that increases TGF-B activity, such as an antibody or antigen-binding fragment that binds to TGF-B or one of its receptors. In some embodiments, the agent that is a TGF-B agonist or stimulator and / or its receptor is a small molecule, a protein or peptide or a nucleic acid.
[00524] [00524] In some embodiments, the agent is an MCP-1 antagonist or inhibitor (CCL2) or an MCP-1 receptor (for example, MCP-1 receptor CCR2 or CCR4). In some aspects, the agent is an antibody that neutralizes MCP-1 activity, such as an antibody or antigen-binding fragment that binds to MCP-1 or one of its receptors (CCR2 or CCR4). In some embodiments, the MCP-1 antagonist or inhibitor is any one described in Gong et al. J Exp Med. July 7, 1997; 186 (1): 131-137 or Shahrara et al. J. Immunol 2008; 180: 3447-3456. In some embodiments, the agent that is an antagonist or inhibitor of MCP-1 and / or its receptor (CCR2 or CCR4) is a small molecule, a protein or peptide or a nucleic acid.
[00525] [00525] In some embodiments, the agent is an IFN-y antagonist or inhibitor or an IFN-y receptor (IFNGR). In some ways, the agent is an antibody that neutralizes IFN-y activity, such as an antibody or antigen-binding fragment that binds to the
[00526] [00526] In some embodiments, the agent is an antagonist or inhibitor of IL-10 or IL-10 receptor (IL-10R). In some ways, the agent is an antibody that neutralizes IL-10 activity, such as an antibody or antigen-binding fragment that binds to I1L-10 or IL-10R. In some respects, the IL- neutralizing antibody is any one described in Dobber et a /. Cell Inmunol. February 1995; 160 (2): 185-92 or Hunter et al. J. Imnmunol. June 1, 2005; 174 (11): 7368-75. In some embodiments, the agent that is an IL-10 / IL-10R antagonist or inhibitor is a small molecule, a protein or peptide or a nucleic acid.
[00527] [00527] In some embodiments, the agent is an IL-1 or IL-1 receptor (IL-1R) antagonist or inhibitor. In some ways, the agent is an antagonist of the IL-1 receptor, which is a modified form of IL-IR, such as anakinra (see, for example, Fleischmann et a /., (2006) Annals of the rheumatic diseases. 65 (8): 1006-12). In some respects, the agent is an antibody that neutralizes IL-1 activity, such as an antibody or antigen-binding fragment that binds to IL-1 or IL-IR, such as canakinumab (see, also EP 2277543). In some embodiments, the agent that is an IL-1 / IL-1R antagonist or inhibitor is a small molecule, a protein or peptide or a nucleic acid.
[00528] [00528] In some embodiments, the agent is an antagonist or inhibitor of a tumor necrosis factor (TNF) or a tumor necrosis factor (TNFR) receptor. In some aspects, the agent is an antibody that blocks TNF activity, such as an antibody or antigen-binding fragment that binds to a TNF, such as TNFa, or its receptor (TNFR, for example, TNFRp55 or TNFRp75). In some aspects, the agent is selected from inflixóimab, adalimumab, certolizumab pegol, golimumab and etanercept. In some embodiments, the agent that is a TNF / TNFR antagonist or inhibitor is a small molecule, a protein or peptide or a nucleic acid. In some embodiments, the agent is a small molecule that affects TNF, such as lenalidomide (see, for example, Muller et a /. (1999) Bioorganic & Medicinal Chemistry Letters. 9 (11): 1625).
[00529] [00529] In some embodiments, the agent is an antagonist or inhibitor of signaling through Janus kinase (JAK) and two signal transducer and transcription activator (STAT) signaling cascades. JAK / STAT proteins are common components of cytokine signaling and cytokine receptors. In some embodiments, the agent that is a JAK / STAT antagonist or inhibitor, such as ruxolitinib (see, for example, Mesa et al. (2012) Nature Reviews Drug Discovery. 11 (2): 103-104), tofacitinib ( also known as Xeljanz, Jakvinus tasocitinibe and CP-690550), Baricitinib (also known as LY-3009104, INCB-28050), Filgotinibe (G-146034, GLPG-0634), Gandotinibe (LY-2784544), Lestaurtinibe (CEP-701 ), Momelotinib (GS-0387, CYT-387), Pacritinib (SB1518) and Upadacitinib (ABT-494). In some embodiments, the agent is a small molecule, a protein or peptide or a nucleic acid.
[00530] [00530] In some embodiments, the agent is a kinase inhibitor. In some embodiments, the agent is an inhibitor of Bruton's tyrosine kinase (BTK). In some embodiments, the inhibitor is or comprises ibrutinib or acalabrutinib (see, for example, Barrett et al., ASH 58! "Meeting Annual San Diego, CA 3-6 December 2016, Abstract 654; Ruella et al., ASH 58! "Annual Meeting San Diego, CA, December 3-6, 2016, Summary 2159). In some embodiments, the agent is an inhibitor as described in US Patent No.
[00531] [00531] In some embodiments, a device, such as absorbent resin technology with blood or plasma filtration, can be used to reduce cytokine levels. In some embodiments, the device used to reduce cytokine levels is a physical cytokine absorber, such as an extracorporeal cytokine absorber. In some embodiments, a physical cytokine absorber can be used to remove cytokines from the bloodstream in an extracorporeal manner ex vivo. In some embodiments, the agent is a porous polymer. In some embodiments, the agent is CytoSorb (see, for example, Basu et al., Indian J Crit Care Med. (2014) 18 (12): 822-824).
[00532] [00532] In some embodiments, cells for use or administered in connection with the methods provided contain or are modified to contain a modified receptor, for example, a modified antigen receptor, such as a chimeric antigen (RAQ) receptor or a receptor T-cell (RCT). Populations of these cells are also provided, compositions containing these cells and / or enriched for such cells, as in which cells of a certain type, such as T cells or CD8 * or CD4 * cells, are enriched or selected. Among the compositions are pharmaceutical compositions and formulations for administration, as for adoptive cell therapy. Therapeutic methods are also provided for administering the cells and compositions to individuals, for example, patients, according to the methods provided and / or the articles of manufacture or compositions provided.
[00533] [00533] In some embodiments, cells include one or more nucleic acids introduced by genetic engineering and thus express recombinant or genetically engineered products of these nucleic acids. In some embodiments, gene transfer is performed by first stimulating cells, as by combining them with a stimulus that induces a response such as proliferation, survival and / or activation, for example, as measured by the expression of a cytokine or activation marker, followed by transduction of activated cells and expansion in culture to sufficient numbers for clinical applications.
[00534] [00534] Cells generally express recombinant receptors, such as antigen receptors, including functional non-RCT antigen receptors, for example, chimeric antigen receptors (RAQs) and other antigen-binding receptors, such as transgenic T cell receptors (RCTs) ). Also among the receptors are other chimeric receptors. A. Chimeric Antigen Receptors (RAQs)
[00535] [00535] In some embodiments of the methods and uses provided, chimeric receptors, such as chimeric antigen receptors, contain one or more domains that combine a ligand-binding domain (for example, antibody or antibody fragment) that provides specificity for a desired antigen (e.g., tumor antigen) with intracellular signaling domains. In some embodiments, the intracellular signaling domain is a portion of the stimulating or activating intracellular domain, such as a T cell stimulating or activating domain, providing either a primary activation signal or a primary signal. In some embodiments, the intracellular signaling domain contains or additionally contains a co-stimulating signaling domain to facilitate effector functions. In some modalities, chimeric receptors when genetically modified in immune cells can modulate T cell activity and, in some cases, modulate T cell differentiation or homeostasis, resulting in genetically modified cells with greater longevity, survival and / or persistence in vivo , as for use in adoptive cell therapy methods.
[00536] [00536] Exemplary antigen receptors, including RAQs, and methods for engineering and introducing such receptors into cells, include those described, for example, in international patent application publication numbers WO200014257, WO2013126726, WO 2012/129514, WO2014031687 , WO2013 / 166321, WOZ2013 / 071154, WO2013 / 123061 publication numbers of US patent application US2002131960, US2013287748, US20130149337, US patents Nos .: 6,451,995, 7,446,190, 8,252,592, 8,339,645,
[00537] [00537] Chimeric receptors, such as RAQs, generally include an extracellular antigen-binding domain, such as a portion of an antibody molecule, usually a heavy chain (VH) variable region and / or light chain (V. 1) of the antibody, for example, a scFv antibody fragment.
[00538] [00538] In some embodiments, the receptor-directed antigen is a polypeptide. In some modalities, it is a carbohydrate or another molecule. In some embodiments, the antigen is selectively expressed or overexpressed in the cells of the disease or condition, for example, the tumor or pathogenic cells, as compared to normal or undirected cells or tissues. In other embodiments, the antigen is expressed on normal cells and / or is expressed on modified cells.
[00539] [00539] In some embodiments, the receptor-directed antigen is or comprises selected from the integrin avB6 (integrin avb6), B cell maturation antigen (AMCB), B7-H3, B7-H6, carbonic anhydrase 9 (CA9, also known as CAIX or G250), a cancer testicle antigen, cancer / testicle 1B antigen (CTAG, also known as NY-ESO-1 and LAGE-2), carcinoembryonic antigen (CEA), a cyclin, cyclin A2, ligand of chemokine Motif CC 1 (CCL-1), CD19, CD20, CD22, CD23, CD24, CD30, CD33, CD38, CD44, CD44v6, CD44v7 / 8, CD123, CD133, CD138, CD171, chondroitin sulfate proteoglycan 4 ( CSPG4), epidermal growth factor protein (EGFR),
[00540] [00540] In some modalities, the scFv and / or Vx domains are derived from FMC63. FMC63 generally refers to a mouse monoclonal IgG1 antibody produced against Nalm-1 and - 16 cells expressing human CD19 (Ling, N. R ,, et al. (1987). Leucocyte typing Ill. 302). The FMC63 antibody comprises CDRH1 and H2 established in SEQ ID NOS: 38, 39 respectively, and CDRH3 established in SEQ ID NOS: 40 or 54 and CDRL1 established in SEQ ID NOS: 35 and CDR L2 36 or 55 and CDR L3 sequences 37 or 56. The FMC63 antibody comprises the heavy chain (VH) variable region comprising the amino acid sequence of SEQ ID NO: 41 and the light chain variable region (V.) comprising the amino acid sequence of SEQ ID NO: 42. In In some embodiments, svFv comprises a variable light chain containing the CDRL1 sequence of SEQ ID NO: 35, a CDRL2 sequence of SEQ ID NO: 36 and a CDRL3 sequence of SEQ ID NO: 37 and / or a variable heavy chain containing a CDRH1 sequence of SEQ ID NO: 38, a CDRH2 sequence of SEQ ID NO: 39 and a sequence of
[00541] [00541] In some modalities, scFv is derived from SJ25C1. SJ25C1 is a mouse monoclonal IgG1 antibody raised against Nalm-1 and -16 cells that express human CD19 (Ling, N. R., et al. (1987). Leucocyte typing Ill. 302). The SJ25C1 antibody comprises CDRH1, H2 and H3 established in SEQ ID NOS: 47-49, respectively, and the sequences CDRL1, L2 and L3 established in SEQ ID NOS: 44-46, respectively. The SJ25C1 antibody comprises the variable region of the heavy chain (Vn) comprising the amino acid sequence of SEQ ID NO: 50 and the variable region of the light chain (V.) comprising the amino acid sequence of SEQ ID NO: 51. In some embodiments , svFv comprises a variable light chain containing the sequence of
[00542] [00542] In some embodiments, the chimeric antigen receptor includes an extracellular portion containing an antibody or antibody fragment. In some aspects, the chimeric antigen receptor includes an extracellular portion containing the antibody or fragment and an intracellular signaling domain. In some embodiments, the antibody or fragment includes an scFv.
[00543] [00543] In some embodiments, the antibody portion of the recombinant receptor, for example, RAQ, further includes at least a portion of an immunoglobulin constant region, such as an articulation region, for example, an I9G4 and / or a Cr1 / CL and / or Fc region. In some embodiments, the region or constant portion is a human IgG, such as IgG4 or
[00544] [00544] In some embodiments, the region or constant portion is a human IgG, such as IgG4 or IgG1. In some embodiments, the spacer has the sequence ESKYGPPCPPCP (set out in SEQ ID NO: 1) and is encoded by the sequence set out in SEQ ID NO:
[00545] [00545] In some embodiments, the antigen receptor comprises an intracellular domain linked directly or indirectly to the extracellular domain. In some embodiments, the chimeric antigen receptor includes a transmembrane domain linking the extracellular domain and the intracellular signaling domain. In some - modalities, the intracellular signaling domain comprises an ITAM. For example, in some respects, the antigen recognition domain (eg, extracellular domain) is usually linked to one or more intracellular signaling components, such as signaling components that mimic activation through an antigen receptor complex, such as a RCT complex, in the case of a RAQ and / or signal via another cell surface receptor. In some embodiments, the chimeric receptor comprises a transmembrane domain linked or fused between the extracellular domain (e.g., scFv) and the intracellular signaling domain. Thus, in some embodiments, the antigen-binding component (e.g., antibody) is linked to one or more domains of transmembrane and intracellular signaling.
[00546] [00546] In one embodiment, a transmembrane domain that is naturally associated with one of the domains on the receiver, for example, RAQ, is used. In some cases, the transmembrane domain is selected or modified by substituting amino acids to prevent binding of such domains to the transmembrane domains of the same or different proteins of the superficial membrane to minimize interactions with other members of the receptor complex.
[00547] [00547] The transmembrane domain in some modalities is derived from a natural source or a synthetic source. Where the source is natural, in some ways, the domain is derived from any membrane-bound or transmembrane protein. Transmembrane regions include those derived (that is, comprise at least the transmembrane regions) from the alpha, beta or zeta chain of the T cell receptor, CD28, CD3 epsilon, CD45, CDA4, CD5, CD8, CD9, CD16, CD22, CD33 , CD37, CD64, CD80, CD86, CD134, CD137, CD154. Alternatively, the transmembrane domain in some modalities is synthetic. In some respects, the synthetic transmembrane domain comprises predominantly hydrophobic residues, such as leucine and valine. In some respects, a phenylalanine, tryptophan and valine triplet will be found at each end of a synthetic transmembrane domain. In some embodiments, the connection is made by ligands, spacers and / or transmembrane domains. In some respects, the transmembrane domain contains a transmembrane portion of CD28.
[00548] [00548] In some modalities, the extracellular domain and the transmembrane domain can be linked directly or indirectly. In some embodiments, the extracellular domain and the transmembrane are connected by a spacer, like any one described here. In some embodiments, the receptor contains an extracellular portion of the molecule from which the transmembrane domain is derived, such as an extracellular CD28 portion.
[00549] [00549] —Among domains of intracellular signaling are those that mimic or approximate a signal through a natural antigen receptor, a signal through that receptor in combination with a co-stimulatory receptor and / or a signal through a co-stimulatory receptor alone. In some embodiments, a short oligo- or polypeptide linker, for example, a linker of 2 to 10 amino acids in length, such as one containing glycine and serine, for example, glycine-serine doublet, is present and forms a link between the transmembrane domain and the cytoplasmic signaling domain of the RAQ.
[00550] [00550] T cell activation is, in some respects, described as mediated by two classes of cytoplasmic signal sequences: those that initiate primary antigen-dependent activation through RCT (primary cytoplasmic signal sequences) and those that act independently of antigen provide a secondary or co-stimulatory signal (secondary cytoplasmic signal sequences). In some respects, the RAQ includes one or both of the signaling components.
[00551] [00551] The receiver, for example, the RAQ, usually includes at least one component or components of intracellular signaling. In some respects, the RAQ includes a primary cytoplasmic signaling sequence that regulates the primary activation of the RCT complex. Primary cytoplasmic signaling sequences that act in a stimulating manner may contain signaling motifs that are known as immunoreceptor tyrosine-based activation motifs or ITAMs. Examples of ITAM containing primary cytoplasmic signal sequences include those derived from the CD3 zeta chain, FCºR gamma, CD3 gamma, CD3 delta and CD3 epsilon. In some embodiments, the cytoplasmic signaling molecule (s) in the RAQ contain (em) a cytoplasmic signaling domain, a portion thereof, or a sequence derived from the CD3 zeta.
[00552] [00552] In some embodiments, the receptor includes an intracellular component of an RCT complex, such as a CD3 CDR chain that mediates T cell activation and cytotoxicity, for example, CD3 zeta chain. Thus, in some aspects, the antigen-binding portion is linked to one or more cell signaling modules. In some embodiments, cellular signaling modules include the CD3 transmembrane domain, CD3 intracellular signaling domains and / or other CD transmembrane domains. In some embodiments, the receptor, for example, RAQ, further includes a portion of one or more additional molecules, such as the Fc y, CD8, CDA4, CD25 or CD16 receptor. For example, in some respects, the RAQ or other chimeric receptor includes a chimeric molecule between CD3-zeta (CD3-Z) or Fc y and CD8, CD4, CD25 or CD16 receptor.
[00553] [00553] In some embodiments, by binding the RAQ or another chimeric receptor, the cytoplasmic domain or the intracellular signaling domain of the receptor activates at least one of the normal effector functions or responses of the immune cell, for example, T cell designed to express the RAQ. For example, in some contexts, RAQ induces a T cell function, such as cytolytic activity or auxiliary T activity, such as cytokine secretion or other factors. In some embodiments, a truncated portion of an intracellular signaling domain of an antigen receptor component or costimulatory molecule is used in place of an intact immunostimulatory chain, for example, if it transduces the signal of the effector function. In some embodiments, the intracellular signaling domain or domains include the cytoplasmic sequences of the T cell receptor (RCT) and, in some respects, also those of co-receptors that in the natural context act in conjunction with these receptors to initiate signal transduction after the antigen involvement of the receptor.
[00554] [00554] In the context of a natural RCT, complete activation generally requires not only signaling through the RCT, but also a co-stimulating signal. Thus, in some modalities, to promote full activation, a component to generate a secondary signal or co-stimulator is also included in the RAQ. In other modalities, the RAQ does not include a component to generate a co-stimulating signal. In some ways, an additional RAQ is expressed in the same cell and provides the component to generate the secondary or co-stimulator signal.
[00555] [00555] In some embodiments, the chimeric antigen receptor contains an intracellular domain of a T cell co-stimulating molecule. In some embodiments, the RAQ includes a signaling domain and / or transmembrane portion of a co-stimulating receptor, such as CD28, 4- 1BB, OX40, DAP10 and ICOS. In some respects, the same RAQ includes the activation and costimulation components. In some embodiments, the chimeric antigen receptor contains an intracellular domain derived from a T cell co-stimulator molecule or a functional variant thereof, such as between the transmembrane domain and the intracellular signaling domain. In some ways, the T cell co-stimulating molecule is CD28 or 41BB.
[00556] [00556] In some modalities, the activation domain is included within an RAQ, while the co-stimulator component is provided by another RAQ recognizing another antigen. In some embodiments, RAQs include activating or stimulating RAQs, co-stimulating RAQs, both expressed in the same cell (see, WOZ2014 / 055668). In some ways, cells include one or more RAQ stimulators or activators and / or a RAQ stimulator. In some embodiments, cells also include inhibitory RAQs (iRAQs, see, Fedorov et al., Sci. Transl. Medicine, 5 (215) (December 2013), as a RAQ that recognizes an antigen different from that associated and / or specific for the disease or condition in which an activation signal delivered via the disease target RAQ is diminished or inhibited by binding the inhibitory RAQ to its ligand, for example, to reduce off-target effects.
[00557] [00557] In certain embodiments, the intracellular signaling domain comprises a transmembrane and CD28 signaling domain linked to an intracellular CD3 domain (e.g., CD3-zeta). In some embodiments, the intracellular signaling domain comprises a chimeric CD28 and CD137 (4- 1BB, TNFRSF9) co-stimulatory domain, linked to a CD3 zeta intracellular domain.
[00558] [00558] In some embodiments, the RAQ encompasses one or more, for example, two or more co-stimulatory domains and an activation domain, for example, primary activation domain, in the cytoplasmic portion.— Examples of RAQs include intracellular components of CD3- zeta, CD28 and 4-1BB.
[00559] [00559] In some embodiments, the antigen receptor further includes a marker and / or expression cells from the RAQ or other antigen receptor further includes a substitute marker, such as a cell surface marker, which can be used to confirm transduction or engineering the cell to express the receptor. In some respects, the marker includes all or part (e.g., truncated form) of CD34, an NGFR or epidermal growth factor receptor, such as the truncated version of that cell surface receptor (for example, tEGFR). In some embodiments, the nucleic acid encoding the marker is operably linked to a polynucleotide that encodes a linker sequence, such as a cleavable linker sequence, for example, T2A. For example, a marker and, optionally, a binding sequence, can be any as described in published patent application No. WO2014031687. For example, the marker can be a truncated EGFR (tEGFR) which is optionally linked to a linker sequence, such as a T2A cleavable linker sequence.
[00560] An exemplary polypeptide for a truncated EGFR (e.g., tEGFR) comprises the amino acid sequence set out in SEQ ID NO: 7 or 16 or an amino acid sequence that exhibits at least 85%, 86%, 87%, 88% , 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more of sequence identity of SEQ ID NO: 7 or 16. An example of T2A the linker sequence comprises the amino acid sequence set out in SEQ ID NO: 6 or 17 or an amino acid sequence that exhibits at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92 %, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more of SEQ ID NO: 6 or 17 sequence identity.
[00561] [00561] In some embodiments, the marker is a molecule, for example, cell surface protein, not found naturally in T cells or not found naturally on the surface of T cells or in a portion of them. In some embodiments, the molecule is a non-self molecule, for example, non-self protein, that is, one that is not recognized as "self" by the host's immune system in which the cells will be transferred adoptively.
[00562] [00562] In some modalities, the marker has no therapeutic function and / or produces another effect besides being used as a marker for genetic engineering, for example, to select successfully modified cells. In other embodiments, the marker may be a therapeutic molecule or molecule that exerts some desired effect, such as a ligand for a cell to be found in vivo, such as an immunostimulatory or immunological checkpoint molecule to improve and / or dampen the responses of cells through adoptive transfer and encounter with ligand.
[00563] [00563] In some cases, RAQs are referred to as first, second and / or third generation RAQs. In some respects, a first generation RAQ is one that only provides a signal induced by the CD3 chain after binding to the antigen; in some ways, a second generation RAQ is one that provides that signal and co-stimulating signal, such as one that includes an intracellular signaling domain from a co-stimulating receptor such as CD28 or CD137; in some respects, a third-generation RAQ is one that includes multiple co-stimulatory domains from different co-stimulatory receptors.
[00564] [00564] For example, in some embodiments, the RAQ contains an antibody, for example, an antibody fragment, a transmembrane domain that is or contains a transmembrane portion of CD28 or a functional variant thereof and an intracellular signaling domain containing a signaling portion of CD28 or its functional variant and signaling portion of CD3 zeta or its functional variant. In some embodiments, the RAQ contains an antibody, for example, antibody fragment, a transmembrane domain that is or contains a transmembrane portion of CD28 or a functional variant thereof and an intracellular signaling domain containing a signaling portion of a 4- 1BB or functional variant and a portion of CD3 signaling zeta or its functional variant. In some of these embodiments, the receiver further includes a spacer containing a portion of an Ig molecule, such as a human Ig molecule, such as an Ig joint, for example, an I9G4 joint, as a joint-only spacer.
[00565] [00565] In some embodiments, the transmembrane domain of the recombinant receptor, for example, the RAQ, is or includes a transmembrane domain of human CD28 (for example, accession number PO1747.1) or its variant, as a transmembrane domain that comprises the amino acid sequence set out in SEQ ID NO: 8 or an amino acid sequence that exhibits at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94% , 95%, 96%, 97%, 98%, 99% or more of SEQ ID NO: 8 sequence identity; in some embodiments, the portion containing the transmembrane domain of the recombinant receptor comprises the amino acid sequence set forth in SEQ ID NO: 9 or an amino acid sequence of at least 85%, 86%, 87%, 88%, 89%, 90% , 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more of sequence identity.
[00566] [00566] In some embodiments, the recombinant receptor intracellular signaling component (s), for example, the RAQ, contains an intracellular co-stimulating signaling domain of human CD28 or a functional variant or portion thereof, such as a domain with a substitution of LL to GG at positions 186-187 of a native CD28 protein. For example, the intracellular signaling domain may comprise the amino acid sequence set out in SEQ ID NO: 10 or 11 or an amino acid sequence that exhibits at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more sequence identity with SEQ ID NO: 10 or 11. In some embodiments, the intracellular domain comprises a 4-1BB intracellular co-stimulator signaling domain (for example, (accession number Q07011.1) or functional variant or part of it, such as the amino acid sequence set out in SEQ ID NO: 12 or an amino acid sequence that displays at least 85 %, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more of sequence identity SEQ ID NO: 12.
[00567] [00567] In some embodiments, the intracellular signaling domain of the recombinant receptor, for example, the RAOQ, comprises a stimulating signaling domain of the human CD3 zeta or a functional variant thereof, such as a 112 AA cytoplasmic domain of the CD36 isoform 3 human (accession no .: P20963.2) or a CD3 zeta signaling domain as described in US Patent No. 7,446,190 or US Patent No. 8,911,993. For example, in some embodiments, the intracellular signaling domain comprises the amino acid sequence as set out in SEQ ID NO: 13, 14 or 15 or an amino acid sequence that exhibits at least 85%, 86%, 87%, 88%, 89%,
[00568] [00568] In some respects, the spacer contains only one hinge region of an IgG, such as only one hinge of IgG4 or IgG1, as the hinge spacer set out in SEQ ID NO: 1. In other embodiments, the spacer is or contains a joint of lg, for example, a joint derived from I1gGA4, optionally linked to a Cr2 and / or Crx3 domain. In some embodiments, the spacer is a lg joint, for example, an IgG4 joint, linked to the Crx2 and Cr3 domains, as set out in SEQ ID NO: 4. In some embodiments, the spacer is a lg joint, for example , an IgGA4 joint, linked only to a Cr3 domain, as set out in SEQ ID NO: 3. In some embodiments, the spacer is or comprises a sequence rich in glycine serine or other flexible linker, as known flexible linkers.
[00569] [00569] For example, in some embodiments, the RAQ includes an antibody, such as an antibody fragment, including scFvs, a spacer, such as a spacer that contains a portion of an immunoglobulin molecule, such as a hinge region and / or a or more constant regions of a heavy chain molecule, such as a spacer containing | hinge, a transmembrane domain containing all or a portion of a CD28-derived transmembrane domain, a CD28-derived intracellular signaling domain and a CD3 zeta signaling domain . In some embodiments, the RAQ includes an antibody or fragment, such as scFv, a spacer like any of the spacers that contain lg joints, a transmembrane domain derived from CD28, an intracellular signaling domain derived from 4-1BB and a signaling domain derived from CD3 zeta.
[00570] [00570] In some embodiments, the nucleic acid molecules encoding these RAQ constructs further include a sequence encoding a T2A ribosomal hop element and / or a tEGFR sequence, for example, downstream of the sequence encoding the RAQ.
[00571] [00571] Recombinant receptors, such as RAQs, expressed by cells administered to the individual generally recognize or specifically bind to a molecule that is expressed in, associated with and / or specific to the disease or condition or cells to be treated. After specific binding to the molecule, for example, antigen, the receptor generally releases an immunostimulatory signal, such as a signal transduced by ITAM, in the cell, thus promoting an immune response directed to the disease or condition. For example, in some embodiments, cells express an RAQ that specifically binds to an antigen expressed by a cell or tissue of the disease or condition or associated with the disease or condition. B. T Cell Receptors (RCTs)
[00572] [00572] In some embodiments, modified cells, such as T cells, used in connection with the methods, uses, articles of manufacture or compositions provided are cells expressing a T cell receptor (RCT) or an antigen binding portion of the even if it recognizes a peptide epitope or T cell epitope of a target polypeptide, such as a tumor antigen, viral or autoimmune protein.
[00573] [00573] In some embodiments, a "T cell receptor" or "RCT" is a molecule that contains variable A and B chains (also known as RCTa and RCTRB, respectively) or variable Y chains (also known as RCTa and RCTRB, respectively), or their antigen-binding portions, and which is able to specifically bind to a peptide attached to an MHC molecule. In some modalities, the RCT is in the form aB. Typically, the ROCTs that exist in the aB and vyó forms are generally structurally similar, but the T cells that express them may have different anatomical sites or functions. An RCT can be found on the surface of a cell or in soluble form. Usually, an RCT is found on the surface of T cells (or T lymphocytes), where it is usually responsible for the recognition of antigens attached to the molecules of the major histocompatibility complex (MHC).
[00574] [00574] Unless otherwise indicated, the term "RCT" should be understood to include complete RCTs, as well as antigen-binding portions or their antigen-binding fragments. In some modalities, ROCT is an intact or complete RCT, including RCTs in the af or yó form. In some embodiments, the ROT is an antigen-binding portion that is smaller than a full-length RCT, but that binds to a specific peptide attached to an MHC molecule, as it binds to an MHC peptide complex. In some cases, an antigen-binding portion or fragment of an RCT may contain only a portion of the structural domains of an entire or intact RCT, but it is still capable of binding the peptide epitope, such as the MHC-peptide complex, to which the Full ROCT turns on. In some cases, an antigen-binding portion contains the variable domains of an RCT, such as the variable chain and the variable B chain of an RCT, sufficient to form a binding site for binding to a specific MHC peptide complex. Generally, the variable chains of an RCT contain complementarity determining regions involved in the recognition of the peptide, MHC and / or MHC-peptide complex.
[00575] [00575] In some modalities, the variable domains of the ROT contain hypervariable loops, or complementarity determining regions (CDRs), which are generally the main contributors to the recognition of antigens and binding capabilities and specificity. In some embodiments, an RCT from an RCT or a combination thereof forms all or substantially the entire antigen-binding site of a given RCT molecule. The various CDRs within a variable region of an RCT chain are generally separated by structural regions (FRs), which generally exhibit less variability between RCT molecules compared to CDRs (see, for example, Jores et al., Proc Nat'l Acad Sci. USA 87: 9138, 1990; Chothia et al, EMBO J. 7: 3745, 1988; see also Lefranc et al., Dev. Comp. Immunol. 27:55, 2003). In some modalities, CDR3 is the main CDR responsible for antigen binding or specificity or is the most important among the three CDRs in a given RCT variable region for antigen recognition and / or interaction with the processed peptide portion of the peptide-MHC complex. In some contexts, CDR1 of the alpha chain can interact with the N-terminal part of certain antigenic peptides. In some contexts, CDR1 of the beta chain can interact with the C-terminal part of the peptide. In some contexts, CDR2 contributes more strongly to or is the main CDR responsible for the interaction or recognition of the MHC portion of the MHC-peptide complex. In some embodiments, the variable region of the B chain may contain an additional hypervariable region (CDR4 or HVRA4), which is generally involved in the binding of superantigens and not in the recognition of antigens (Kotb (1995) Clinical Microbiology Reviews, 8: 411-426 ).
[00576] [00576] In some embodiments, an RCT may also contain a constant domain, a transmembrane domain and / or a short cytoplasmic tail (see eg Janeway et al, Immunobiology: The Immune System in Health and Disease, 3rd Ed ,, Current Biology Publications, for example, 4:33, 1997). In some respects, each RCT chain may have an N-terminal immunoglobulin variable domain, an immunoglobulin constant domain, a transmembrane region and a short cytoplasmic tail at the C-terminal end. In some modalities, an RCT is associated with invariant proteins of the CD3 complex involved in mediating signal transduction.
[00577] [00577] In some embodiments, an RCT chain contains one or more constant domains. For example, the extracellular portion of a given RCT chain (for example, chain a or chain 8) can contain two immunoglobulin-like domains, as a variable domain (for example, Va or VB; typically amino acids 1 to 116 on the numbering by Kabat Kabat et al., "Sequences of Proteins of Immunological Interest, US Dept. Health and Human Services, Public Health Service National Institutes of Health, 1991, 5th ed.) and a constant domain (for example, constant domain of the chain a or Ca, typically places 117 to 259 of the chain based on the Kabat numbering or constant domain of the B or Cr chain; typically places 117 to 295 of the chain based on Kabat) adjacent to the cell membrane. cases, the extracellular portion of the RCT formed by the two chains contains two constant domains proximal to the membrane and two variable domains distal to the membrane, whose variable domains contain CDRs. The constant domain of the RCT can contain connection sequences cu runs in which a cysteine residue forms a disulfide bond, thus linking the two chains of the RCT. In some embodiments, an RCT may have an additional cysteine residue in each of the a and B chains, so that the RCT contains two disulfide bonds in the constant domains.
[00578] [00578] In some embodiments, the ROCT chains contain a transmembrane domain. In some embodiments, the transmembrane domain is positively charged. In some cases, the RCT chain contains a cytoplasmic tail. In some cases, the structure allows the RCT to associate with other molecules such as CD3 and its subunits. For example, an RCT containing constant domains with a transmembrane region can anchor the protein in the cell membrane and associate with invariant subunits of the CD3 signaling apparatus or complex. The intracellular tails of the CD3 signaling subunits (for example, CD3y, CD35, CD3e and CD376 chains) contain one or more tyrosine-based immunoreceptor or ITAM activation motifs that are involved in the RCT complex signaling ability.
[00579] [00579] In some embodiments, the RCT can be a two-chain heterodimer a and B (or optionally y and 5) or it can be a single-chain RCT construction. In some embodiments, ROCT is a heterodimer containing two separate chains (chains a and B or chains y and 5) that are linked, such as by a disulfide bond or disulfide bonds.
[00580] [00580] In some embodiments, the ROT can be generated from a known RCT sequence, such as Va, B chain sequences, for which a substantially complete coding sequence is readily available. Methods for obtaining life-size RCT sequences, including V-chain sequences, from cell sources are well known. In some embodiments, the nucleic acids encoding the RCT can be obtained from a variety of sources, such as by polymerase chain reaction (PCR) amplification of the nucleic acids encoding the RCT within or isolated from a given cell or cells or synthesis of publicly available RCT DNA sequences.
[00581] [00581] In some embodiments, RCT is obtained from a biological source, such as T cell cells (eg, cytotoxic T cell), T cell hybridomas or another publicly available source. In some embodiments, T cells can be obtained from cells isolated in vivo. In some modalities, the RCT is a timidly selected RCT. In some modalities, RCT is an RCT restricted to neoepitopes. In some embodiments, T cells can be a hybridoma or cultured T cell clone. In some embodiments, the RCT or its antigen-binding portion or its antigen-binding fragment can be generated synthetically from knowledge of the RCT sequence.
[00582] [00582] In some embodiments, the ROCT is generated from an RCT identified or selected from the screening of an RCTs against a target polypeptide antigen or its target T cell epitope. RCT libraries can be generated by amplifying the repertoire of Va and VB from T cells isolated from an individual, including cells present in PBMCs, spleen or other lymphoid organ. In some cases, T cells can be amplified from tumor-infiltrating lymphocytes (TlLs). In some embodiments, RCT libraries can be generated from CD4 * or CD8 * cells. In some embodiments, ROTs can be amplified from a normal healthy individual's T cell source, i.e., normal RCT libraries. In some embodiments, RCTs can be amplified from a source of T cells from a sick individual, i.e., libraries of sick RCTs. In some modalities, degenerate primers are used to amplify the genetic repertoire of Va and VB, as by RT-PCR in samples, such as T cells, obtained from humans. In some embodiments, scTv libraries can be assembled from naive Va and VB libraries in which the amplified products are cloned or assembled to be separated by a ligand. Depending on the individual's source and cells, the libraries may be specific to the HLA allele. Alternatively, in some modalities, RCT libraries can be generated by mutagenesis or diversification of a parent or scaffold RCT molecule. In some aspects, RCTs are individuals with directed evolution, as by mutagenesis, for example, of the a or B chain. In some aspects, specific residues in the RCTs of the RCT are altered. In some modalities, the selected RCTs can be modified by affinity maturation. In some embodiments, antigen-specific T cells can be selected, such as by screening to assess CTL activity against the peptide. In some respects, ROTs, for example, present in antigen-specific T cells, can be selected, such as by binding activity, for example, particular affinity or avidity for the antigen.
[00583] [00583] In some modalities, the ROT or its antigen-binding portion is that which has been modified or constructed. In some modalities, directed evolution methods are used to generate RCTs with altered properties, as with greater affinity for a specific MHC-peptide complex. In some modalities, targeted evolution is achieved by display methods, including, but not limited to, yeast display (Holler et a /. (2003) Nat Immunol, 4, 55-62; Holler et al. (2000) Proc Natl Acad Sci USA, 97, 5387-92), phage display (Li et al. (2005) Nat Biotechnol, 23, 349- 54) or T cell display (Chervin et a /. (2008) J Immunol Methods, 339, 175-84). In some modalities, exhibition approaches involve building or modifying a known, originating or reference RCT. For example, in some cases, a wild type RCT can be used as a model to produce mutagenized RCTs in which one or more CDR residues are mutated and mutants with a desired altered property, such as increased affinity for a desired target antigen, are selected. .
[00584] [00584] In some embodiments, peptides from a target polypeptide for use in the production or generation of an RCT of interest are known or can be easily identified. In some embodiments, peptides suitable for use in generating RCTs or antigen-binding moieties can be determined based on the presence of an HLA-restricted motif in a target polypeptide of interest, such as a target polypeptide described below. In some embodiments, peptides are identified using available computer prediction models. In some embodiments, for predicting MHC class | binding sites, these models include, but are not limited to, ProPred1i (Singh and Raghava (2001) Bioinformatics 17 (12): 1236-1237 and SYFPEITHI (see Schuler et a /. (2007)) Imnmunoinformtics Methods in Molecular Biology, 409 (1): 75-93, 2007. In some embodiments, the MHC-restricted epitope is HLA-A0O201, which is expressed in approximately 39-46% of all Caucasians and therefore represents an appropriate choice of the MHC antigen for use in the preparation of an RCT or other MHC peptide binding molecule.
[00585] [00585] HLA-A0O201 binding motifs and cleavage sites for proteasomes and immunoproteasomes using computer prediction models are known. To predict MHC class | binding sites, these models include, but are not limited to, ProPred1 (described in more detail in Singh and Raghava, ProPred: prediction of HLA-DR binding. BIOINFORMATICS 17 (12): 1236-1237 2001 ) and SYFPEITHI (see, Schuler et al. SYFPEITHI, Database for Searching and T-Cell Epitope Prediction. in Immunoinformatics Methods in Molecular Biology, vol 409 (1): 75-93 2007)
[00586] [00586] In some embodiments, the RCT or its antigen-binding portion may be a natural protein produced recombinantly or a mutated form in which one or more properties, as a binding characteristic, have been altered. In some embodiments, an RCT can be derived from one of several animal species, such as a human, mouse, rat, or other mammal. An RCT can be attached to the cell or in soluble form. In some embodiments, for the purposes of the methods provided, the RCT is in cell-bound form, expressed on the surface of a cell.
[00587] [00587] In some modalities, the ROCT is a full-size RCT. In some embodiments, ROCT is an antigen-binding moiety. In some modalities, ROCT is a dimeric RCT (ARCT). In some modalities, the RCT is a single chain RCT (sc-RCT). In some embodiments, a dRCT or scRCT has the structures described in WO 03/020763, WO 04/033685, WO 2011/044186.
[00588] [00588] In some embodiments, the ROCT contains a sequence corresponding to the transmembrane sequence. In some embodiments, the RCT contains a sequence corresponding to cytoplasmic sequences. In some modalities, ROCT is able to form an RCT complex with CD3. In some embodiments, any of the RCTs, including a dRCT or scRCT, can be linked to signaling domains that produce an active RCT on the surface of a T cell. In some embodiments, the RCT is expressed on the surface of the cells.
[00589] [00589] In some embodiments, a dRCT contains a first polypeptide in which a sequence corresponding to a sequence of the variable region of the RCT a chain is fused to the N-terminus of a sequence corresponding to an extracellular sequence of the region constant of the RCT a chain and a second polypeptide in which a sequence corresponding to a sequence of the variable region of the RCT-p chain is fused to the N-terminus; a sequence corresponding to an extracellular sequence of the RCT-p chain constant region, the first and second polypeptides being linked by a disulfide bond. In some embodiments, the bond may correspond to the native interchain disulfide bond present in aB native dimeric RCTs. In some embodiments, the interchain disulfide bonds are not present in a native RCT. For example, in some embodiments, one or more cysteines can be incorporated into the extracellular sequences of the region contained in the dRCT polypeptide pair. In some cases, a native and a non-native disulfide bond may be desirable. In some embodiments, the ROCT contains a transmembrane sequence to anchor in the membrane.
[00590] [00590] In some embodiments, a dRCT contains a RCT chain a containing a variable domain, a constant domain and a first dimerization motif linked to the C terminal of the constant domain and a ROCT B chain comprising a variable B domain , a constant B domain and a first dimerization motif attached to the C terminal of the constant B domain, where the first and second dimerization motifs interact easily to form a covalent bond between an amino acid in the first dimerization motif and an amino acid in the second dimerization motif that links the RCT a chain and the RCT B chain together.
[00591] [00591] In some modalities, the RCT is a scRCT. Typically, a scRCT can be generated using known methods. See, for example, Soo Hoo, W. F. et al. PNAS (USA) 89, 4759 (1992); Wulfing, C. and Pluckthun, A., J. Mol. Biol. 242, 655 (1994); Kurucz, |. et al. PNAS (USA) 90 3830 (1993); International PCT published in. WO 96/13593, WO 96/18105, WOS99 / 60120, WO99 / 18129, WO 03/020763, WO2011 / 044186; and Schlueter, C.J. et al. J. Mol. Biol. 256, 859 (1996). In some embodiments, a scRCT contains a non-native disulfide interlink bond introduced to facilitate the association of RCT chains (see, for example, PCT published international publication No. WO 03/020763). In some embodiments, a scRCT is a non-disulfide truncated RCT in which heterologous leucine zippers fused to its C-terminals facilitate chain association (see, for example, published international PCT No. WO99 / 60120). a scRCT contains an RCTa variable domain covalently linked to an RCTB variable domain by means of a peptide linker (see, for example, published international PCT No. WO99 / 18129).
[00592] [00592] In some embodiments, a scRCT contains a first segment - consisting of a sequence of amino acids corresponding to a variable region of the a chain of the RCT, a second segment consisting of a sequence of amino acids corresponding to a sequence of the variable region of the ROT chain B fused to the N-terminus of an amino acid sequence corresponding to an extracellular sequence of constant domain of the RCT B chain and a linker sequence that connects the C-terminus of the first segment to the N-terminus of the second segment.
[00593] [00593] In some embodiments, a scRCT contains a first segment consisting of a variable region sequence of chain a fused to the N-terminus of an extracellular constant domain sequence of chain a and a second segment consisting of a variable region sequence of chain B fused to the N-terminus of an extracellular chain constant It is of the transmembrane sequence and sequence and, optionally, a linker sequence that connects the C-terminus of the first segment to the N-terminus of the second segment.
[00594] [00594] In some embodiments, a scRCT contains a first segment consisting of a variable region sequence of RCT B chain fused to the N-terminus of an extracellular constant domain sequence of chain B and a second segment consisting of a sequence of variable region of a chain fused to the N-terminus of an extracellular sequence constant of the a-chain and transmembrane sequence and, optionally, a linker sequence that links the C-terminus of the first segment to the N-terminus of the second segment.
[00595] [00595] In some embodiments, the linker of a scRCTs that links the first and second segments of RCT can be any linker capable of forming a single polypeptide strand, maintaining the specificity of binding to the RCT. In some embodiments, the linker sequence may, for example, have the formula -P-AA-P-, where P is proline and AA represents an amino acid sequence where the amino acids are glycine and serine. In some embodiments, the first and second segments are paired so that the sequences of the variable region of the same are oriented for that connection. Therefore, in some cases, the linker is long enough to cover the distance between the C terminal of the first segment and the N terminal of the second segment, or vice versa, but it is not too long to block or reduce the SCcRCT connection to the target ligand. In some embodiments, the linker may contain from or about 10 to 45 amino acids, such as 10 to 30 amino acids or 26 to 41 amino acid residues, for example, 29, 30, 31 or 32 amino acids. In some embodiments, the linker has the formula -PGGG- (SGGGG) 5-P-, where P is proline, G is glycine and S is serine (SEQ ID NO: 28). In some embodiments, the linker has the sequence GSADDAKKDAAKKDGKS (SEQ ID NO: 29)
[00596] [00596] In some embodiments, scRCT contains a covalent disulfide bond that binds a residue from the immunoglobulin region of the chain constant domain to a residue from the immunoglobulin region of the B chain constant domain. In some embodiments, the disulfide bond interchanges in a native RCT is not present. For example, in some embodiments, one or more cysteines can be incorporated into the extracellular sequences of the region contained in the first and second segments of the SscRCT polypeptide. In some cases, a native and a non-native disulfide bond may be desirable.
[00597] [00597] In some embodiments of a dRCT or scRCT containing introduced interchain disulfide bonds, native disulfide bonds are not present. In some embodiments, one or more of the native cysteines that form a native interchain disulfide bond are replaced by another residue, such as a serine or alanine. In some embodiments, an introduced disulfide bond can be formed by mutating non-cysteine residues in the first and second cysteine segments. Examples of non-native disulfide bonds from an RCT are described in published International POT No. WO2006 / 000830.
[00598] [00598] In some embodiments, the RCT or its antigen binding fragment exhibits an affinity with an equilibrium binding constant for a target antigen between or between about 10- and 10-12 M and all individual values and ranges. In some embodiments, the target antigen is an MHC-peptide complex or ligand.
[00599] [00599] In some embodiments, the nucleic acid or nucleic acids encoding an RCT, such as the a and B chains, can be amplified by PCR, cloning or other suitable means and cloned into a suitable expression vector or vectors. The expression vector can be any suitable recombinant expression vector and can be used to transform or transfect any suitable host. Suitable vectors include those designed for propagation and expansion or expression or both, such as plasmids and viruses.
[00600] [00600] In some modalities, the vector can be a vector from the pUC series (Fermentas Life Sciences), from the pBluescript series (Stratagene, LaJolla, California), from the pET series (Novagen, Madison, Wis.), From the PGEX series (Pharmacia Biotech , Uppsala, Sweden) or the pEX series (Clontech, Palo Alto, California). In some cases, vectors of bacteriophages, such as AG10, AGT11, AZapll (Stratagene), AEMBL4 and ANM1149, can also be used. In some embodiments, plant expression vectors can be used and include pBlIO1, PBI101.2, pBI101.3, pBl121 and pBINI9 (Clontech) In some embodiments, animal expression vectors include pEUK-CI, PMAM and pMAMneo (Clontech) ). In some embodiments, a viral vector is used, such as a retroviral vector.
[00601] [00601] In some embodiments, recombinant expression vectors can be prepared using standard recombinant DNA techniques. In some embodiments, the vectors may contain regulatory sequences, such as transcription and translation initiation and termination codons, which are specific to the type of host (for example, bacteria, fungus, plant or animal) into which the vector must be introduced, as appropriate and taking into account whether the vector is based on DNA or RNA. In some embodiments, the vector may contain a non-native promoter operably linked to the nucleotide sequence encoding the ROCT or the antigen-binding portion (or another MHC peptide-binding molecule). In some embodiments, the promoter may be a non-viral promoter or a viral promoter, such as a cytomegalovirus (CMV) promoter, an SV40 promoter, an RSV promoter and a promoter found in the long terminal repeat of the murine virus stem cell. Other well-known promoters are also considered.
[00602] [00602] In some embodiments, to generate a vector encoding an RCT, the a and B chains are amplified by PCR from the total cCDNA isolated from a T cell clone expressing the RCT of interest and cloned into an expression vector. In some embodiments, strands a and B are cloned into the same vector. In the modalities, the a and B chains are cloned into different vectors. In some embodiments, the generated a and B chains are incorporated into a retroviral vector, for example, lentiviral. Genetically Modified Cells and Cell Production Methods
[00603] [00603] In some embodiments, the methods provided involve administering to an individual with a disease or condition of cells expressing a recombinant antigen receptor. Various methods for introducing genetically modified components, for example, recombinant receptors, for example, RAQs or RCTs, are well known and can be used with the methods and compositions provided. Exemplary methods include those for transferring nucleic acids that encode receptors, including viral, for example, retroviral or lentiviral, transduction, transposons and electroporation.
[00604] [00604] Among the expression cells of the receptors and administered by the methods provided are the modified cells. Genetic engineering usually involves introducing a nucleic acid that encodes the recombinant or modified component into a composition containing the cells, such as by transduction, transfection or retroviral transformation. C. Chimeric Autoantibody Receptors (CAARs)
[00605] [00605] In some embodiments, between the recombinant receptor expressed by the modified cells used in connection with the methods, uses, articles of manufacture and compositions provided is a chimeric autoantibody (CAAR) receptor In some embodiments, CAAR is specific for an autoantibody . In some embodiments, a cell that expresses CAAR, such as a T cell designed to express a CAAR, can be used to specifically bind and kill autoantibody expression cells, but not normal antibody expression cells. In some embodiments, CAAR expression cells can be used to treat an autoimmune disease associated with the expression of autoantigens, such as autoimmune diseases. In some embodiments, CAAR expression cells can target B cells that ultimately produce autoantibodies and exhibit autoantibodies on their cell surfaces, marking these B cells as specific disease targets for therapeutic intervention. In some embodiments, CAAR expression cells can be used to efficiently target and kill pathogenic B cells in autoimmune diseases, targeting disease-causing B cells using an antigen-specific chimeric autoantibody receptor. In some embodiments, the recombinant receptor is a CAAR, like any described in U.S. Pub. Patent Application. No. US 2017/0051035.
[00606] [00606] In some embodiments, CAAR comprises an autoantibody binding domain, a transmembrane domain and an intracellular signaling region. In some embodiments, the intracellular signaling region comprises an intracellular signaling domain. In some embodiments, the intracellular signaling domain is or comprises a primary signaling domain, a signaling domain that is capable of inducing a primary activation signal in a T cell, a signaling domain of a component of the T cell receptor ( RCT) and / or a signaling domain comprising an immunoreceptor tyrosine-based activation motif (ITAM) In some embodiments, the intracellular signaling region comprises a secondary or co-stimulating region (secondary intracellular signaling regions).
[00607] [00607] In some embodiments, the autoantibody binding domain comprises an autoantigen or a fragment thereof. The choice of autoantigen may depend on the type of autoantibody being targeted. For example, the autoantigen can be chosen because it recognizes an autoantibody in a target cell, such as a B cell, associated with a specific disease state, for example, an autoimmune disease, such as an autoimmune mediated autoimmune disease. In some embodiments, the autoimmune disease includes pemphigus vulgaris (PV). Exemplary autoantigens include desmoglein 1 (Dsg1) and Dsg3. D. Multiple directions
[00608] [00608] In some embodiments, the cells used in connection with the methods, uses, articles of manufacture and compositions provided include cells that employ multiple targeting strategies, such as expression of two or more genetically modified receptors in the cell, each recognizing the same of a different antigen and typically each including a different intracellular signaling component. Such multi-targeting strategies are described, for example, in Patent Application “International, Publication No: WO 2014055668 A1 (describing combinations of activating and co-stimulating RAQs, for example, targeting two different antigens present individually outside the target, for example , normal cells, but present together only in the cells of the disease or condition to be treated) and Fedorov et al., Sci. Transl. Medicine, 5 (215) (2013) (describing expression cells of an activating RAQ and an inhibitor, such as those in which the activating RAQ binds to an antigen expressed in normal or non-sick cells and in the cells of the disease or condition to be treated and the inhibitory RAQ binds to another antigen expressed only in normal cells or cells that you do not want to treat).
[00609] [00609] For example, in some embodiments, cells include a receptor that expresses a first genetically modified antigen receptor (eg, RAQ or RCT) that is capable of inducing an activating or stimulating signal to the cell, usually by specific binding to the antigen recognized by the first receptor, for example, the first antigen. In some embodiments, the cell also includes a second genetically modified antigen receptor (for example, RAQ or RCT), for example, a chimeric co-stimulatory receptor, capable of inducing a co-stimulatory signal to the immune cell, usually by specifically binding to a second antigen - recognized by the second receptor. "In some modalities, the first antigen and the second antigen are the same. In some modalities, the first antigen and the second antigen are different.
[00610] [00610] In some embodiments, the first and / or the second genetically modified antigen receptor (for example, RAQ or RCT) is able to induce an activation signal for the cell. In some embodiments, the receiver includes an intracellular signaling component containing ITAM or ITAM motifs. In some embodiments, activation induced by the first receptor involves signal transduction or changes in protein expression in the cell, resulting in the initiation of an immune response, such as ITAM phosphorylation and / or the initiation of the signal transduction cascade mediated by ITAM, the formation of an immune synapse and / or grouping of molecules close to the bound receptor (for example, CD4 or CDB8, etc.), activation of one or more transcription factors, such as NF-KB and / or AP-1, and / or induction of gene expression of factors such as cytokines, proliferation and / or survival.
[00611] [00611] In some embodiments, the first and / or the second receptor include intracellular signaling domains or co-stimulating receptor regions, such as CD28, CD137 (4-1BB), OX40 and / or ICOS. In some embodiments, the first and second recipients include an intracellular signaling domain of a co-stimulatory receptor that are different. In one embodiment, the first receptor contains a CD28 costimulatory signaling region and the second receiver contains a 4-1BB costimulatory signaling region or vice versa.
[00612] [00612] In some embodiments, the first and / or the second receptor includes an intracellular signaling domain containing ITAM or ITAM-like motifs and an intracellular signaling domain of a co-stimulating receptor.
[00613] [00613] In some embodiments, the first receptor contains an intracellular signaling domain containing ITAM or ITAM-like motifs, and the second receptor contains an intracellular signaling domain of a co-stimulating receptor. The co-stimulatory signal in combination with the activation signal induced in the same cell is one that results in an immune response, such as a robust and prolonged immune response, such as increased gene expression, cytokine secretion and other factors and T cell-mediated effector like cell death.
[00614] [00614] In some embodiments, neither the binding of the first receptor alone nor the binding of the second receptor alone induces a robust immune response. In some respects, if only one receptor is bound, the cell becomes tolerated or does not respond to the antigen or inhibited and / or is not induced to proliferate or secrete factors or perform effector functions. In some of these modalities, however, when the plurality of receptors is linked, as in the encounter of a cell that expresses the first and the second antigens, a desired response is achieved, such as complete immune activation or stimulation, for example, as indicated by secretion of one or more cytokines, proliferation, persistence and / or performance of an immune effector function, such as the cytotoxic death of a target cell.
[00615] [00615] In some embodiments, the two receptors induce, respectively, an activation and inhibitory signal to the cell, so that the binding of one of the receptors to its antigen activates the cell or induces a response, but the binding by the second inhibitory receptor its antigen induces a signal that suppresses or dampens that response. Examples are combinations of activating RAQs and inhibitory RAQs or IiRAQs. This strategy can be used, for example, in which the activating RAQ binds an antigen expressed in a disease or condition, but which is also expressed in normal cells, and the inhibitory receptor binds to a separate antigen that is expressed in normal cells, but not disease or condition cells.
[00616] [00616] In some modalities, the multiple segmentation strategy is employed in a case in which an antigen associated with a specific disease or condition is expressed in a non-sick cell and / or is expressed in the modified cell itself, whether in a transient way (for example, through stimulus associated with genetic engineering) or permanently. In such cases, by requiring the connection of two separate and individually specific antigen receptors, specificity, selectivity and / or effectiveness can be improved.
[00617] [00617] In some embodiments, the plurality of antigens, for example, the first and second antigens, are expressed in the cell, tissue or disease or condition being targeted, as in cancer cells. In some ways, the cell, tissue, disease, or condition is multiple myeloma or a multiple myeloma cell. In some embodiments, one or more of the plurality of antigens is generally also expressed in a cell that is not desired to be reached with cell therapy, such as a normal or non-diseased cell or tissue and / or the modified cells themselves. In such embodiments, by requiring the binding of multiple receptors to obtain a cell response, specificity and / or efficacy is achieved. E. Vectors and Methods for Genetic Engineering
[00618] [00618] In some embodiments, modified cells, such as T cells, used in connection with methods, uses, articles of manufacture or compositions are cells that have been genetically modified to express a recombinant receptor, for example, a RAQ or an RCT described here in. In some embodiments, cells are modified by introducing, releasing or transferring nucleic acid sequences that encode the recombinant receptor and / or other molecules.
[00619] [00619] In some embodiments, recombinant nucleic acids are transferred to cells using recombinant infectious virus particles, such as, for example, vectors derived from simian virus 40 (SV40), adenovirus, adeno-associated virus (AAV). In some embodiments, recombinant nucleic acids are transferred to T cells using recombinant lentiviral vectors or retroviral vectors, such as gamma-retroviral vectors (see, for example, Koste et al. (2014) Gene Therapy April 3, 2014. doi: 10.1038 / gt. 2014.25; Carlens et a /. (2000) Exp Hematol 28 (10): 1137-46; Alonso-Camino et al. (2013) Mol Ther Nucl Acids 2, e93; Park et a /., Trends Biotechnol November 29, 2011 (11): 550-557.
[00620] [00620] In some embodiments, the retroviral vector has a long terminal repeat sequence (LTR), for example, a retroviral vector derived from Moloney's murine leukemia virus (MoMLV), myeloproliferative sarcoma virus (MPSV), murine embryonic stem cell (MESV), murine stem cell virus (MSCV), spleen focus forming virus (SFFV) or adeno-associated virus (AAV). Most retroviral vectors are derived from murine retroviruses. In some embodiments, retroviruses include those derived from any source of avian or mammalian cells. Retroviruses are typically amphoteric, meaning that they are capable of infecting host cells of various species, including humans. In one embodiment, the gene to be expressed replaces the retroviral sequences of gag, pol and / or env. A number of illustrative retroviral systems have been described (for example, US patents 5,219,740; 6,207,453; 5,219,740; Miller and Rosman (1989) BioTechniques 7: 980-990; Miller, AD (1990) Human Gene Therapy 1: 5-14 Scarpa et a /. (1991) Virology 180: 849-852; Burns et a /. (1993) Proc. Natl. Acad. Sci. USA 90: 8033-8037; and Boris-Lawrie and Temin (1993) Opin Opin Genet Develop.3: 102-109.
[00621] [00621] Lentiviral transduction methods are known. Exemplary methods are described in, for example, Wang et al. (2012) J. Immunother. 35 (9): 689-701; Cooper et a /. (2003) Blood. 101: 1637-1644; Verhoeyen et al. (2009) Methods Mol Biol. 506: 97-114; and Cavalieri et al. (2003) Blood. 102 (2): 497-505.
[00622] [00622] In some embodiments, recombinant nucleic acids are transferred to T cells by electroporation (see, for example, Chicaybam et al, (2013) PLoS ONE 8 (3): e60298 and Van Tedeloo et a /. (2000) Gene Therapy 7 (16): 1431-1437). In some “modalities, recombinant nucleic acids are transferred to T cells by transposition (see, for example, Manuri et al. (2010) Hum Gene Ther 21 (4): 427-437; Sharma et al. (2013) Molec Ther Nucl Acids 2, e74; and Huang et a /. (2009) Methods Mol Biol 506: 115-126). Other methods of introducing and expressing genetic material into immune cells include transfection of calcium phosphate (for example, as described in Current Protocols in Molecular Biology, John Wiley & Sons, New York. New York), protoplast fusion, mediated transfection by cationic liposomes; bombardment of microparticles facilitated by tungsten particles (Johnston, Nature, 346: 776-777 (1990)); and strontium phosphate DNA coprecipitation (Brash et a /., Mol. Cell Biol., 7: 2031-2034 (1987)).
[00623] [00623] Other approaches and vectors for transferring the nucleic acids encoding the recombinant products are those described, for example, in international patent application, Publication No .: WO 2014055668 and U.S. Patent No. 7,446,190.
[00624] [00624] In some embodiments, cells, for example, T cells, can be transfected during or after expansion, for example, with a T cell receptor (RCT) or a chimeric antigen receptor (RAQ). This transfection for the introduction of the desired receptor gene can be performed with any suitable retroviral vector, for example. The population of genetically modified cells can then be released from the initial stimulus (the anti-CD3 / anti-CD28 stimulus, for example) and subsequently be stimulated with a second type of stimulus, for example, via a newly introduced receptor). This second type of stimulus may include an antigenic stimulus in the form of a peptide / MHC molecule, the cognate ligand (crosslinking) of the genetically introduced receptor (for example, natural ligand of an RAQ) or any ligand (such as an antibody) that binds directly within the structure of the new receptor (for example, recognizing constant regions in the receptor). See, for example, Cheadle et al., "Chimeric antigen receptors for T-cell based therapy" Methods Mol Biol. 2012; 907: 645-66 or Barrett et al., Chimeric Antigen Receptor Therapy for Cancer Annual Review of Medicine vol. 65: 333-347 (2014).
[00625] [00625] In some cases, a vector can be used that does not require cells, for example, T cells, to be activated. In some of these cases, cells can be selected and / or transduced before activation. Thus, cells can be modified before or after culturing the cells and, in some cases, at the same time as or during at least a portion of the culture.
[00626] [00626] Among additional nucleic acids, for example, genes for introduction are those that improve the effectiveness of therapy, as for example, promoting the viability and / or the function of the transferred cells; genes to provide a genetic marker for selection and / or evaluation of cells, as well as to assess survival or localization in vivo; genes to improve safety, for example, making the cell susceptible to negative selection in vivo, as described by Lupton S. D. et al., Mol. and Cell Biol., 11: 6 (1991); and Riddell et al. Human Gene Therapy 3: 319-338 (1992); see also publications PCT / US91 / 08442 and PCT / US94 / 05601 by Lupton et al. describe the use of selectable bifunctional fusion genes derived from the fusion of a dominant positive selectable marker with a negative selectable marker. See, for example, Riddell et a /., US Patent No. 6,040,177, in columns 14-17. F. Cells and Cell Preparation for Genetic Engineering
[00627] [00627] In some embodiments, cells, such as T cells, used in connection with the methods, uses, articles of manufacture or compositions are cells that have been genetically modified to express a recombinant receptor, for example, a RAQ or an RCT described here. In some embodiments, the modified cells are used in the context of cell therapy, for example, adoptive cell therapy. In some embodiments, the modified cells are immune cells. In some embodiments, the modified cells are T cells, such as CD4 * or CD8 * T cells.
[00628] [00628] In some embodiments, nucleic acids, such as nucleic acids encoding a recombinant receptor, are heterologous, that is, they are not normally present in a cell or sample obtained from the cell, such as one obtained from another organism or cell, which for example, it is not normally found in the cell being modified and / or in an organism from which that cell is derived. In some embodiments, nucleic acids are not naturally occurring, like a nucleic acid not found in nature, including one that comprises chimeric combinations of nucleic acids that encode several domains of several different cell types.
[00629] [00629] The cells are generally eukaryotic cells, like mammalian cells, and are generally human cells. In some embodiments, cells are derived from blood, bone marrow, lymph or lymphoid organs, are cells of the immune system, such as cells of innate or adaptive immunity, for example, myeloid or lymphoid cells, including lymphocytes, typically T cells and / or NK cells. Other exemplary cells include stem cells, such as multipotent and pluripotent stem cells, including induced pluripotent stem cells (iPSCs). Cells are typically primary cells, such as those isolated directly from an individual and / or isolated from an individual and frozen. In some embodiments, cells include one or more subsets of T cells or other types of cells, such as entire populations of T cells, CD4 cells ”, CD8 cells * and subpopulations thereof, such as those defined by function, activation state, maturity , potential for differentiation, expansion, recirculation, localization and / or persistence capabilities, antigen specificity, type of antigen receptor, presence in a specific organ or compartment, marker or cytokine secretion profile and / or degree of differentiation. With reference to the individual to be treated, the cells can be allogeneic and / or autologous. Methods include ready-to-use methods. In some respects, as for ready-to-use technologies, cells are pluripotent and / or multipotent, like stem cells, like induced pluripotent stem cells (iPSCs). In some modalities, the methods include isolating cells from the individual, preparing, processing, cultivating and / or designing and reintroducing them to the same individual, before or after cryopreservation.
[00630] [00630] Among the subtypes and subpopulations of T and / or CD4 * and / or CD8 * cells are naive T (Tn) cells, effector T cells (TerF), memory T cells and their subtypes, such as T stem cell memory (Tscvw), central T memory (Tcvw), effective T memory (Tem) or terminally differentiated memory effector cells, tumor infiltrating lymphocytes (TIL), immature T cells, mature T cells, helper T cells, cytotoxic, invariable mucosa-associated T cells mucosa-associated invariant T cells (MAIT), naturally occurring adaptive and adaptive regulatory T cells (Treg), helper T cells, such as TH1 cells, TH2 cells, TH3 cells, TH17 cells, TH17 cells , TH9 cells, TH22 cells, follicular T cells, alpha / beta T cells and delta / gamma T cells.
[00631] [00631] In some embodiments, the cells are natural killer cells (NK). In some embodiments, the cells are monocytes or granulocytes, for example, myeloid cells, macrophages, neutrophils, dendritic cells, mast cells, eosinophils and / or basophils.
[00632] [00632] In some embodiments, cells include one or more nucleic acids introduced by genetic engineering and thus express recombinant or genetically engineered products of such nucleic acids. In some embodiments, nucleic acids are heterologous, that is, they are not normally present in a cell or sample obtained from the cell, such as one obtained from another organism or cell, which, for example, is not normally found in the cell being projected and / or an organism from which that cell is derived. In some embodiments, nucleic acids are not naturally occurring, like a nucleic acid not found in nature, including one that comprises chimeric combinations of nucleic acids that encode several domains of several different cell types.
[00633] [00633] In some embodiments, the preparation of the modified cells includes one or more stages of culture and / or preparation. Cells for introducing the nucleic acid encoding the transgenic receptor, such as RAQ, can be isolated from a sample, such as a biological sample, for example, one obtained or derived from an individual. In some embodiments, the individual from whom the cell is isolated is one who has the disease or condition or needs cell therapy or to whom cell therapy will be administered. The individual in some modalities is a human being who needs a specific therapeutic intervention, such as the adoptive cell therapy for which the cells are being isolated, processed and / or modified.
[00634] [00634] Therefore, cells in some embodiments are primary cells, for example, primary human cells. Samples include tissue, fluid and other samples taken directly from the individual, as well as samples resulting from one or more processing steps, such as separation, centrifugation, genetic engineering (for example, viral vector transduction), washing and / or incubation. The biological sample can be a sample taken directly from a biological source or a sample that is processed. Biological samples include, but are not limited to, body fluids such as blood, plasma, serum, cerebrospinal fluid, synovial fluid, urine and sweat, tissue and organ samples, including processed samples derived from them.
[00635] [00635] In some respects, the sample from which the cells are derived or isolated is blood or a sample derived from blood, or is or is derived from an apheresis or leukapheresis product. Examples of samples include whole blood, peripheral blood mononuclear cells (PBMC), leukocytes, bone marrow, thymus, tissue biopsy, tumor, leukemia, lymphoma, lymph node, lymphoid tissue associated with the intestine, lymphoid tissue associated with the mucosa, spleen, others lymphoid tissues, liver, lung, stomach, intestine, colon, kidney, pancreas, breast, bone, prostate, cervix, testicles, ovaries, tonsils or other organ and / or cells derived from them. Samples include, in the context of cell therapy, for example, adoptive cell therapy, samples from autologous and allogeneic sources.
[00636] [00636] In some embodiments, the cells are derived from cell lines, for example, T cell lines. The cells in some embodiments are obtained from a xenogenic source, for example, from mice, rats, non-human primates and pigs .
[00637] [00637] In some embodiments, cell isolation includes one or more stages of preparation and / or separation by cells without affinity. In some examples, cells are washed, centrifuged and / or incubated in the presence of one or more reagents, for example, to remove unwanted components, enrich for desired components, lyse or remove cells sensitive to specific reagents. In some examples, cells are separated based on one or more properties, such as density, adherent properties, size, sensitivity and / or resistance to specific components.
[00638] [00638] In some examples, an individual's circulating blood cells are obtained, for example, by apheresis or leukapheresis. The samples, in some respects, contain lymphocytes, including T cells, monocytes, granulocytes, B cells, other nucleated white blood cells, red blood cells and / or platelets and, in some aspects, contain cells other than red blood cells and platelets.
[00639] [00639] In some embodiments, the blood cells collected from the individual are washed, for example, to remove the plasma fraction and place the cells in an appropriate buffer or medium for subsequent processing steps. In some embodiments, the cells are washed with phosphate buffered saline (PBS). In some embodiments, the washing solution lacks calcium and / or magnesium and / or many or all divalent cations. In some respects, a washing step is performed with a semi-automated "full flow" centrifuge (eg the Cobe 2991, Baxter) according to the manufacturer's instructions. In some aspects, a washing step is performed by tangential flow filtration (TFF) according to the manufacturer's instructions. In some embodiments, cells are resuspended in a variety of biocompatible buffers after washing, such as, for example, Ca * / Mg ** free PBS. In certain embodiments, the components of a blood cell sample are removed and the cells are resuspended directly in the culture media.
[00640] [00640] In some embodiments, the methods include cell separation methods based on density, such as preparing white blood cells from peripheral blood by lysing red blood cells and centrifuging using a Percoll or Ficoll gradient.
[00641] [00641] In some embodiments, isolation methods include separating different types of cells based on the expression or presence in the cell of one or more specific molecules, such as surface markers, for example, surface proteins, intracellular markers or acid nucleic. In some embodiments, any known method for separation based on such markers can be used. In some embodiments, separation is a separation based on affinity or immunoaffinity. For example, isolation in some aspects includes the separation of cells and cell populations based on the expression or level of expression of cells from one or more markers, typically cell surface markers, for example, by incubation with an antibody or binding that specifically binds to such markers, generally followed by steps of washing and separating cells that have bound to the antibody or binding partner, from those cells that have not bound to the antibody or binding partner.
[00642] [00642] Such separation steps can be based on positive selection, in which cells that bound the reagents are retained for later use and / or negative selection, in which cells that do not bind to the antibody or binding partner are retained. In some instances, both fractions are retained for later use. In some respects, negative selection can be particularly useful when there is no antibody available that specifically identifies a cell type in a heterogeneous population, so that separation is best performed based on markers expressed by cells other than the desired population.
[00643] [00643] The separation need not result in 100% enrichment or removal of a specific cell population or expression cells of a specific marker. For example, positive selection or enrichment for cells of a specific type, such as those that express a marker, refers to increasing the number or percentage of those cells, but it does not have to result in a complete absence of cells that do not express the marker. Likewise, negative selection, removal or depletion of cells of a specific type, such as those that express a marker, refers to the decrease in the number or percentage of these cells, but it does not have to result in the complete removal of all these cells.
[00644] [00644] In some examples, several rounds of separation steps are carried out, where the selected fraction positively or negatively from one stage is subjected to another separation stage, as a subsequent positive or negative selection. In some examples, a single separation step can deplete the expression cells of several markers simultaneously, such as incubating cells with a plurality of antibodies or binding partners, each specific for a marker targeted for negative selection. Likewise, several types of cells can be selected positively simultaneously by incubating cells with a plurality of antibodies or binding partners expressed in the various types of cells.
[00645] [00645] For example, in some respects, specific subpopulations of T cells, such as positive cells or expressing high levels of one or more surface markers, for example, CD28 ", CD62L *, COCR7 *, CD27 *, CD127 *, CD4 *, CD8 *, CD45RA * and / or CD45RO * T cells, are isolated by positive or negative selection techniques.
[00646] [00646] For example, CD3 *, CD28 * T cells can be selected positively using conjugated anti-CD3 / anti-CD28 magnetic beads (eg, DYNABEADSO M-450 CD3 / CD28 T cell expander).
[00647] [00647] In some modalities, isolation is performed by enrichment for a specific cell population by positive selection, or depletion of a specific cell population by negative selection. In some embodiments, positive or negative selection is performed by incubating cells with one or more antibodies or another binding agent that specifically bind to one or more expressed or expressed surface markers (marker *) at a relatively higher level (high marker) ) in the positive or negative selected cells, respectively.
[00648] [00648] In some embodiments, T cells are separated from a PBMC sample by negative selection of markers expressed in non-T cells, such as B cells, monocytes or other white blood cells, such as CD14. In some respects, a CD4 * or CD8 * selection step is used to separate CD4 * and CD8 * helper cytotoxic T cells. Such CD4 * and CD8 * populations can be classified into subpopulations by positive or negative selection for markers expressed or expressed to an actively higher degree in one or more subpopulations of naive, memory and / or effector T cells.
[00649] [00649] In some embodiments, CD8 * cells are further enriched or depleted from naive stem cells, central memory, effective memory and / or stem cells from central memory, as by positive or negative selection based on surface antigens associated with the respective subpopulation. In some embodiments, central memory T cell (TCM) enrichment is performed to increase efficacy, such as to improve long-term survival, expansion and / or graft after administration, which in some respects is particularly robust in these subpopulations. See Terakura et al. (2012) Blood.1: 72-82; Wang et al. (2012) J. Immunother. 35 (9): 689-701. In some embodiments, the combination of CD8 * T cells enriched with TCM and CD4 * T cells further improves effectiveness.
[00650] [00650] In modalities, memory T cells are present in the CD62L * and CD62L- subsets of peripheral blood lymphocytes
[00651] [00651] In some embodiments, enrichment for central memory T cells (TCM) is based on the positive or high surface expression of CD45RO, CD62L, CCR7, CD28, CD3 and / or CD127; in some respects, it is based on negative selection for cells expressing or expressing CD45RA and / or granzyme B. In some respects, the isolation of a CD8 * population enriched for TOM cells is accomplished by depletion of CDA4 expression cells, CD14, CD45RA, and positive selection or enrichment for CD62L expression cells. In one aspect, enrichment of central memory T cells (TCM) is performed starting with a negative fraction of cells selected based on the expression of CDA4, which is subjected to a negative selection based on the expression of CD14 and CD45RA and a selection positive based on CD62L. Such selections in some aspects are made simultaneously and in other aspects they are made sequentially, in any order. In some respects, the same selection step based on CD4 expression used in the preparation of the CD8 * cell population or subpopulation is also used to generate the CD4 * cell population or subpopulation, so that the positive and negative fractions of the separation CD4-based tests are retained and used in subsequent method steps, optionally following one or more positive or negative selection steps.
[00652] [00652] In a particular example, a sample of PBMCs or another sample of white blood cells is subjected to the selection of CD4 cells *, where the negative and positive fractions are kept. The negative fraction is then subjected to negative selection based on the expression of
[00653] [00653] CD4 * T helper cells are classified into naive, central memory and effector cells, identifying populations of cells that have cell surface antigens. CD4 * lymphocytes can be obtained by standard methods. In some embodiments, the naive CD4 * T lymphocytes are CD45RO-, CD45RA ”*, CD62L *, CD4 * cells. In some embodiments, the central memory CD4 * cells are CD62L * and CD45RO *. In some embodiments, CD4 * effector cells are CD62L- and CD45RO-.
[00654] [00654] In one example, to enrich CD4 * cells by "negative" selection, a cocktail of monoclonal antibodies typically includes antibodies to CD14, CD20, CD11b, CD16, HLA-DR and CD8. In some embodiments, the antibody or binding partner is attached to a support or solid matrix, such as a magnetic sphere or paramagnetic sphere, to allow separation of cells for positive and / or negative selection. For example, in some embodiments, cells and cell populations are separated or isolated using immunomagnetic separation (or magnetic affinity) techniques (reviewed in Methods in Molecular Medicine, vol. 58: Metastasis Research Protocols, Vol. 2: Cell Behavior In Vitro and In Vivo, for example, 17-25 Edited by: SA Brooks and U. Schumacher The Humana Press Inc., Totowa, NJ).
[00655] [00655] In some respects, the sample or composition of cells to be separated is incubated with small, magnetizable or magnetically responsive material, such as particles or microparticles that are magnetically responsive, such as paramagnetic beads (eg, Dynalbeads or MACS beads). The magnetically responsive material, for example, particle, is usually directly or indirectly linked to a binding partner, for example, an antibody that specifically binds to a molecule, for example, surface marker, present in the cell, cells or population of cells that he wants to separate, for example, that he wants to select negatively or positively.
[00656] [00656] In some embodiments, the particle or magnetic bead comprises a responsive material magnetically attached to a specific binding member, such as an antibody or other binding partner. There are many known magnetically responsive materials used in magnetic separation methods. Suitable magnetic particles include those described in Molday, Pat.
[00657] [00657] Incubation is usually performed under conditions whereby antibodies or binding partners, or molecules, such as secondary antibodies or other reagents, which specifically bind to those antibodies or binding partners, which are bound to the particle or magnetic bead, specifically bind to cell surface molecules, if present in the sample cells.
[00658] [00658] In some respects, the sample is placed in a magnetic field and cells that have magnetically responsive or magnetizable particles attached to it will be attracted to the magnet and separated from unidentified cells. For positive selection, the cells attracted by the magnet are retained; for negative selection, cells that are not attracted (unmarked cells) are retained. In some aspects, a combination of positive and negative selection is performed during the same selection step, in which the positive and negative fractions are retained and further processed or subjected to additional separation steps.
[00659] [00659] In certain embodiments, the magnetically responsive particles are coated on primary antibodies or other binding partners, secondary antibodies, lectins, enzymes or streptavidin. In certain embodiments, the magnetic particles are connected to the cells through a coating of primary antibodies specific to one or more markers. In certain embodiments, cells, instead of spheres, are labeled with a primary antibody or binding partner and then added - magnetic particles coated with cell-specific secondary antibody or another binding partner (e.g. streptavidin)) In certain embodiments, streptavidin-coated magnetic particles are used in conjunction with biotinylated primary or secondary antibodies.
[00660] [00660] In some embodiments, the magnetically responsive particles are left attached to the cells that must subsequently be incubated, cultured and / or modified; in some respects, the particles are left attached to the cells for administration to a patient. In some embodiments, the magnetizable or magnetically responsive particles are removed from the cells. Methods for removing magnetizable particles from cells are known and include, for example, the use of competing unlabeled antibodies and magnetizable particles or antibodies conjugated to cleavable ligands. In some embodiments, the magnetizable particles are biodegradable.
[00661] [00661] In some modalities, the affinity-based selection is via magnetically activated cell classification (MACS) (Miltenyi Biotec, Auburn, CA). The Activated Cell Magnetic Classification (MACS) systems are capable of selecting high purity cells with magnetized particles attached to them. In certain modalities, MACS operates in a way in which the non-target and target species are sequentially eluted after the application of the external magnetic field. That is, the cells attached to the magnetized particles are kept in place while the unbound species are eluted. Then, after the completion of this first elution step, the species that were captured in the magnetic field and prevented from being eluted are released in some way, so that they can be eluted and recovered. In certain embodiments, non-target cells are labeled and depleted from the heterogeneous cell population.
[00662] [00662] In certain embodiments, isolation or separation is performed using a system, device or apparatus that performs one or more of the isolation, cell preparation, separation, processing, incubation, culture and / or method formulation steps. In some ways, the system is used to perform each of these steps in a closed or sterile environment, for example, to minimize errors, user manipulation and / or contamination. In one example, the system is a system as described in International Patent Application, Publication Number WOZ2009 / 072003 or US 20110003380 A1.
[00663] [00663] In some modalities, the system or device performs one or more, for example, all isolation, processing, engineering and formulation steps in an integrated or independent system, and / or in an automated or programmable manner. In some aspects, the system or device includes a computer and / or computer program in communication with the system or device, which allows the user to program, control, evaluate the result and / or adjust various aspects of processing, isolation, engineering steps and formulation.
[00664] [00664] In some aspects, the separation and / or other steps are performed using the CIiniMACS system (Miltenyi Biotec), for example, for automatic separation of cells at the clinical scale level in a closed and sterile system. Components can include an integrated microcomputer, magnetic separation unit, peristaltic pump and several pinch valves. The integrated computer in some aspects controls all components of the instrument and instructs the system to perform repeated procedures in a standardized sequence. The magnetic separation unit in some aspects includes a movable permanent magnet and a support for the selection column. The peristaltic pump controls the flow throughout the piping set and, together with the pinch valves, ensures the controlled flow of buffer through the system and the continuous suspension of the cells.
[00665] [00665] The CIliniMACS system, in some aspects, uses magnetizable particles coupled to antibodies that are supplied in a sterile and non-pyrogenic solution. In some embodiments, after labeling the cells with magnetic particles, the cells are washed to remove excess particles. A cell preparation bag is then connected to the tube set, which in turn is connected to a bag containing a buffer and a cell collection bag. The tube set consists of pre-assembled sterile tubes, including a precolumn and a separation column, and are for single use only. After the separation program starts, the system automatically applies the cell sample to the separation column. The marked cells are retained in the column, while the unlabeled cells are removed by a series of washing steps. In some embodiments, cell populations for use with the methods described herein are not marked and are not retained in the column. In some embodiments, cell populations for use with the methods described herein are marked and retained in the column. In some embodiments, cell populations for use with the methods described here are eluted from the column after removing the magnetic field and are collected inside the cell collection bag.
[00666] [00666] In certain modalities, the separation and / or other steps are performed using the CIiniMACS Prodigy system (Miltenyi Biotec). The CIliniMACS Prodigy system, in some aspects, is equipped with a cell processing unit that allows automated washing and fractionation of cells by centrifugation. The CIiniMACS Prodigy system can also include an integrated camera and image recognition software that determines the ideal end point for cell fractionation, discerning the macroscopic layers of the product from the source cell. For example, peripheral blood is automatically separated into erythrocytes, white blood cells and plasma layers. The CIiniMACS Prodigy system can also include an integrated cell culture chamber that performs cell culture protocols, such as cell differentiation and expansion, antigen loading and long-term cell culture. Inlet ports can allow sterile removal and media replacement, and cells can be monitored using an integrated microscope. See, for example, Klebanoff et al. (2012) J. Immunother. 35 (9): 651-660, Terakuraet al. (2012) Blood.1: 72-82, and Wang et al. (2012) J Immunother. 35 (9): 689-701.
[00667] [00667] In some embodiments, a cell population described here is collected and enriched (or depleted) by flow cytometry, in which cells stained by various cell surface markers are transported in a fluidic stream. In some modalities, a population of cells described here is collected and enriched (or depleted) by means of classification on a preparative scale (FACS). In certain embodiments, a population of cells described here is collected and enriched (or depleted) by using microelectromechanical system chips (MEMS) in combination with a FACS-based detection system (see, for example, WO 2010/033140, Cho et a /. (2010) Lab Chip 10, 1567-1573; and Godin et a /. (2008) J. Biophoton. 1 (5): 355-376. In both cases, cells can be labeled with various markers, allowing the isolation of well-defined elements. T cell subsets with high purity.
[00668] [00668] In some embodiments, antibodies or binding partners are labeled with one or more detectable markers, to facilitate separation for positive and / or negative selection. For example, the separation can be based on binding to fluorescently labeled antibodies. In some examples, separation of cells based on the binding of antibodies or other specific binding partners to one or more cell surface markers is carried out in a fluidic stream, such as by fluorescence-activated cell classification (FACS), including preparative scale ( FACS) and / or microelectromechanical system chips (MEMS), for example, in combination with a flow cytometric detection system. Such methods allow for positive and negative selection based on multiple markers simultaneously.
[00669] [00669] In some embodiments, the preparation methods include freezing steps, for example, cryopreservation, cells, before or after isolation, incubation and / or construction. In some embodiments, the subsequent freezing and thawing step removes granulocytes and, to some extent, monocytes in the cell population. In some embodiments, the cells are suspended in a freezing solution, for example, after a washing step to remove plasma and platelets.
[00670] [00670] In some embodiments, cells are incubated and / or cultured before or in connection with genetic engineering. Incubation steps can include culture, cultivation, stimulation, activation and / or propagation. Incubation and / or construction can be performed in a culture vessel, such as a unit, chamber, well, column, tube, tubing set, valve, flask, culture plate, bag or other container for culture or culture cells. In some embodiments, the compositions or cells are incubated in the presence of stimulating conditions or a stimulating agent. Such conditions include those designed to induce cell proliferation, expansion, activation and / or survival in the population, to mimic exposure to the antigen and / or to prepare the cells for genetic engineering, such as for the introduction of a recombinant antigen receptor.
[00671] [00671] Conditions may include one or more specific media, temperature, oxygen content, carbon dioxide content, time, agents, for example, nutrients, amino acids, antibiotics, ions and / or stimulating factors, such as cytokines, chemokines, antigens, binding partners, fusion proteins, soluble recombinant receptors and any other agents designed to activate cells.
[00672] [00672] In some embodiments, the stimulating conditions or agents include one or more agents, for example, ligand, which is capable of activating an intracellular signaling domain of an RCT complex. In some respects, the agent binds or initiates the ROCT / CD3 intracellular signaling cascade in a T cell. Such agents may include antibodies, such as those specific for an RCT, for example, anti-CD3. In some embodiments, the stimulating conditions include one or more agents, for example, ligand, which is capable of stimulating a co-stimulating receptor, for example, anti-CD28. In some embodiments, these agents and / or ligands may be attached to a solid support, such as a cord, and / or one or more cytokines. Optionally, the expansion method may further comprise the step of adding anti-CD3 and / or anti-CD28 antibody to the culture medium (for example, at a concentration of at least about 0.55 ng / ml). In some embodiments, stimulating agents include IL-2, IL-15 and / or IL-7. In some respects, the IL-2 concentration is at least about 10 units / ml.
[00673] [00673] In some respects, incubation is performed according to techniques such as those described in US patent 6,040,177 to Riddell et al., Klebanoff et al. (2012) J Imnmunother. 35 (9): 651-660, Terakuraet al. (2012) Blood.1: 72-82, and / or Wang et al. (2012) J. Immunother. 35 (9): 689-701.
[00674] [00674] In some embodiments, T cells are expanded by adding culture-initiating cells, such as undivided peripheral blood mononuclear cells (PBMC) to a composition (for example, so that the resulting cell population contains at least about 5 , 10, 20 or 40 or more PBMC feeder cells for each T lymphocyte in the initial population to be expanded); and incubate the culture (for example, long enough to expand the number of T cells). In some respects, non-dividing feeder cells may comprise gamma-irradiated PBMC feeder cells. In some embodiments, PBMC is irradiated with gamma rays in the range of about 3000 to 3600 rads to prevent cell division. In some respects, feeder cells are added to the culture medium prior to the addition of T cell populations.
[00675] [00675] In some embodiments, the stimulating conditions include adequate temperature for the growth of human T lymphocytes, for example, at least about 25 degrees Celsius, generally at least 30 degrees and generally at or about 37 degrees Celsius. Optionally, the incubation may further comprise the addition of undivided EBV-transformed lymphoblastoid cells (LCL) as feeder cells. The LCL can be irradiated with gamma rays in the range of about 6000 to 10,000 rads. LCL feeder cells in some ways are provided in any suitable amount, such as a ratio of LCL feeder cells to initial T lymphocytes of at least about 10: 1.
[00676] [00676] In modalities, antigen-specific T cells, such as antigen-specific CD4 * and / or CD8 * T cells, are obtained by stimulating naive or antigen-specific T lymphocytes with antigen. For example, antigen-specific T cell lines or clones can be generated for cytomegalovirus antigens by isolating T cells from infected individuals and stimulating cells in vitro with the same antigen. IV. COMPOSITIONS AND FORMULATIONS
[00677] [00677] In some embodiments the dose of cells comprising cells modified with a recombinant antigen receptor, for example, RAQ or RCT, is provided as a composition or formulation, such as a pharmaceutical composition or formulation. These compositions can be used according to the methods or uses provided and / or the articles of manufacture or compositions provided, as an introduction or treatment of diseases, conditions and disorders, or in methods of detection, diagnosis and prognosis.
[00678] [00678] The term "pharmaceutical formulation" refers to a preparation that is such as to allow the biological activity of an active ingredient contained therein to be effective and that does not contain additional components that are unacceptably toxic to an individual to whom the formulation would be administered.
[00679] [00679] A "pharmaceutically acceptable carrier" refers to an ingredient in a pharmaceutical formulation, other than an active ingredient, which is not toxic to an individual. A pharmaceutically acceptable carrier includes, but is not limited to, a buffer, excipient, stabilizer or preservative.
[00680] [00680] In some aspects, the choice of vehicle is determined in part by the specific cell or agent and / or by the method of administration. Therefore, there are a variety of suitable formulations. For example, the pharmaceutical composition can contain preservatives. Suitable preservatives may include, for example, methylparaben, propylparaben, sodium benzoate and benzalkonium chloride. In some ways, a mixture of two or more preservatives is used. The preservative or mixtures thereof are typically present in an amount of about 0.0001% to about 2% by weight of the total composition. The vehicles are described, for example, by Remington's Pharmaceutical Sciences 16th edition, Osol, A. Ed. (1980). Pharmaceutically acceptable carriers are generally non-toxic to receptors at the dosages and concentrations employed and include, but are not limited to: buffers such as phosphate, citrate and other organic acids; antioxidants, including ascorbic acid and methionine; preservatives (such as octadecyldimethylbenzyl ammonium chloride; hexamethonium chloride; benzalkonium chloride; benzethonium chloride; phenol, butyl or benzyl alcohol; paraben alcohol such as methyl or propyl paraben; catechol; resorcinol; cyclohexanol; 3-pentanol; and m- cresol); low molecular weight polypeptides (less than about 10 residues); proteins, such as serum albumin, gelatin or immunoglobulins; hydrophilic polymers such as polyvinylpyrrolidone; - amino acids such as glicinay glutamine, asparagine, histidinay, arginine or lisihaá monosaccharides, disaccharides and other carbohydrates, including glucose, mannose or dextrins; chelating agents such as EDTA; sugars such as sucrose, mannitol, trehalose or sorbitol; salt-forming counterions, such as sodium; metal complexes (for example, Zn protein complexes); and / or non-ionic surfactants, such as polyethylene glycol (PEG).
[00681] [00681] Buffering agents in some aspects are included in the compositions. Suitable buffering agents include, for example, citric acid, sodium citrate, phosphoric acid, potassium phosphate and various other acids and salts. In some aspects, a mixture of two or more buffering agents is used. The buffering agent or mixtures thereof are typically present in an amount of about 0.001% to about 4% by weight of the total composition. Methods for preparing administrable pharmaceutical compositions are known. Exemplary methods are described in more detail, for example, in Remington: The Science and Practice of Pharmacy, Lippincott Williams &Wilkins; 21st ed. (May 1, 2005).
[00682] [00682] The formulation or composition may also contain more than one active ingredient useful for the specific indication, disease or condition being prevented or treated with the cells or agents, where the respective activities do not adversely affect each other. Such active ingredients are suitably present in combination in effective amounts for the intended purpose. Thus, in some embodiments, the pharmaceutical composition further includes other pharmaceutically active agents or drugs, such as chemotherapeutic agents, for example, asparaginase, busulfan, carboplatin, cisplatin, daunorubicin, doxorubicin, fluorouracil, gemcitabine, - hydroxyurea, - methotrexate, —paclitaxel, rituximab, vinitubebe, vincristine, etc. In some embodiments, the agents or cells are administered in the form of a salt, for example, a pharmaceutically acceptable * salt. Suitable pharmaceutically acceptable acid addition salts include those derived from mineral acids, such as hydrochloric, hydrobromic, phosphoric acids , metaphosphoric, nitric and sulfuric and organic acids, such as tartaric, acetic, citric, citric, lactic, fumaric, benzoic, glycolic, glyconic, succinic and arylsulfonic acids, for example, p-toluenesulfonic acid.
[00683] [00683] The pharmaceutical composition in some modalities contains agents or cells in amounts effective to treat or prevent the disease or condition, such as a therapeutically effective or prophylactically effective amount Therapeutic or prophylactic efficacy in some modalities is monitored by periodic evaluation of the treated individuals. For repeated administrations for several days or more, depending on the condition, treatment is repeated until a desired suppression of the symptoms of the disease occurs. However, other dosing regimens can be useful and can be determined. The desired dosage can be administered by a single bolus administration of the composition, by multiple bolus administrations of the composition, or by continuous infusion administration of the composition.
[00684] [00684] The agents or cells can be administered by any suitable means, for example, by bolus infusion, by injection, for example, intravenous or subcutaneous injections, intraocular injection, periocular injection, subretinal injection, intravitreal injection, transseptal, subcleral injection injection, intracoroidal injection, intracameral injection, subconjunctival injection, subconjunctival injection, sub Tenon injection, retrobulbar injection, peribulbar injection or justascleral release - posteriorn In some modalities, they are administered by parenteral, intrapulmonary and intranasal administration and, if desired for local treatment , intralesional administration. Parenteral infusions include intramuscular, intravenous, intraarterial, intraperitoneal or subcutaneous administration. In some embodiments, a given dose is administered by a single bolus administration of the cells or agent. In some embodiments, it is administered by multiple bolus administrations of the cells or agent, for example, over a period not exceeding 3 days, or by administration of continuous infusion of the cells or agent.
[00685] [00685] For the prevention or treatment of the disease, the appropriate dosage may depend on the type of disease to be treated, the type of agent or agents, the type of recombinant cells or receptors, the severity and the course of the disease, if the agent or cells are administered for preventive or therapeutic purposes, prior therapy, medical history and the individual's response to the agent or cells and at the discretion of the attending physician. The compositions are in some embodiments suitably administered to the individual at the same time or during a series of treatments.
[00686] [00686] The cells or agents can be administered using standard delivery techniques, formulations and / or devices. Formulations and devices, such as syringes and vials, are provided for storage and administration of the compositions. With respect to cells, the administration can be autologous or heterologous. For example, immunoresponsive cells or progenitors can be obtained from one individual and administered to the same individual or to a different compatible individual. Immunoresponsive cells derived from peripheral blood or its progeny (for example, derived in vivo, ex vivo or in vitro) can be administered by localized injection, including catheter administration, systemic injection, localized injection, intravenous injection or parenteral administration. When administering a therapeutic composition (for example, a pharmaceutical composition containing a genetically modified immunoresponsive cell or an agent that treats or improves symptoms of neurotoxicity), it is usually formulated in an injectable unit dosage form (solution, suspension, emulsion).
[00687] [00687] The formulations include those for oral, intravenous, intraperitoneal, subcutaneous, pulmonary, transdermal, intramuscular, intranasal, buccal, sublingual or suppository administration. In some embodiments, populations of agents or cells are administered parenterally. The term "parenteral", when used herein, includes intravenous, intramuscular, subcutaneous, rectal, vaginal and intraperitoneal administration. In some embodiments, populations of agents or cells are administered to an individual using peripheral systemic administration by intravenous, intraperitoneal or subcutaneous injection.
[00688] [00688] Compositions in some embodiments are provided as sterile liquid preparations, for example, isotonic aqueous solutions, suspensions, emulsions, dispersions or viscous compositions, which can in some respects be buffered to a selected pH. Liquid preparations are usually easier to prepare than gels, other viscous compositions and solid compositions. In addition, liquid compositions are a little more convenient to administer, especially by injection. Viscous compositions, on the other hand, can be formulated within the appropriate viscosity range to provide longer contact periods with specific fabrics. The liquid or viscous compositions can comprise vehicles, which can be a solvent or dispersing medium containing, for example, water, saline, phosphate buffered saline, polyol (for example, glycerol, propylene glycol, liquid polyethylene glycol) and mixtures thereof appropriate.
[00689] [00689] Sterile injectable solutions can be prepared by incorporating the agent or cells in a solvent, such as in mixture with a suitable vehicle, diluent or excipient, such as sterile water, physiological saline, glucose, dextrose or the like.
[00690] [00690] The formulations to be used for in vivo administration are generally sterile. Sterility can be easily achieved, for example, by filtration through sterile filtration membranes. V. COMBINATION THERAPY
[00691] [00691] In some modalities of the methods, articles of manufacture, uses or compositions, cell therapy, for example, the dose of T cells (for example, T cells RAQ *) is administered to individuals in combination with an agent or therapeutic therapy additional, usually different from cell therapy or other cell therapy, as other than TRAQ * cell therapy. In some embodiments, cell therapy, for example, the dose of genetically modified T cells, such as RAQ * T cells, in the methods or uses provided and / or with the articles of manufacture or compositions, is administered as part of a combined treatment or combined therapy, as simultaneously with, sequentially with or intermittently with, in any order, one or more additional therapeutic interventions. In some embodiments, one or more additional therapeutic interventions includes any agent or treatment for treating or preventing the disease or condition, such as B-cell malignancy, for example, NHL and / or any agent or treatment to increase effectiveness, persistence and / or modified cell therapy activity.
[00692] [00692] In some embodiments, an additional therapeutic agent or therapy is administered to individuals who are or are likely to be or who are expected to be poor responders and / or who are not, are probably not and / or who are not expected to respond or not responding within a certain time and / or to some extent to treatment with cell therapy, for example, T cell dose (eg, RAQ * T cells). In some embodiments, the additional therapeutic agent is administered to individuals who are not or are unlikely to exhibit a complete response or a general response, such as within 1 month, within two months, or within three months after starting administration of cell therapy. In some embodiments, the additional therapeutic agent is administered to individuals who exhibit or are likely to exhibit or are expected to exhibit progressive disease (PD), such as within 1 month, two months or three months, after administration of cell therapy. In some embodiments, it is likely or predicted that an individual will not exhibit a response or a certain response based on a plurality of individuals located in a similar manner, thus treated or previously treated with cell therapy.
[00693] [00693] In some embodiments, it is noted that an individual who may or is more likely to exhibit a weak response to cell therapy, for example, The dose of T cells (eg, T cells RAQ *) includes an individual with NHL who is or has been identified as having stable or progressive disease (ED / PD) after treatment with a previous therapy, optionally a previous therapy with a chemotherapeutic agent, that is or has been identified with a condition
[00694] [00694] In certain embodiments, the pharmacokinetics (PK) of cell therapy in the blood of individuals after administration of cell therapy have been found to be similar or not substantially different among responders (eg exhibit CR or RO) versus not responding (for example, display PD) to cell therapy. In some modalities, these observations indicate that cell therapy has or is expanding in the individual, but may not exhibit optimal effectiveness.
[00695] [00695] “In some contexts, the optimal effectiveness of a cell therapy may depend on the ability of administered cells to recognize and bind to a target, for example, target antigen, to successfully travel, locate and enter the appropriate locations of the individual , tumors and their environments. In some contexts, optimal efficacy may depend on the ability of administered cells to activate, expand and exercise various effector functions, including cytotoxic death and secretion of various factors, such as cytokines, to persist, including in the long run, to differentiate, transition or engage in reprogramming for certain phenotypic states (such as long-term memory, less differentiated and effector states), to prevent or reduce immunosuppressive conditions in the local microenvironment of a disease, to provide effective and robust recall responses after clearance and re-exposure to the ligand or target antigen, and avoid or reduce exhaustion, anergy, peripheral tolerance, terminal differentiation and / or differentiation in a suppressive state.
[00696] [00696] In some aspects, the effectiveness of immunotherapy, for example, T cell therapy, may be limited by the activity or immunosuppressive factors present in the local microenvironment of the disease or disorder, for example, TME. In some respects, TME contains or produces factors or conditions that can suppress T cell activity, function, proliferation, survival and / or persistence administered for T cell therapy.
[00697] [00697] In some embodiments, the administration of an additional agent or therapy, before, concomitantly with or at the same time and / or subsequent to the beginning of the administration of cell therapy, for example, the dose of T cells (for example, T cells RAQ *) can result in improved activity, efficacy and / or the persistence of cell therapy and / or improve the responses of the treated individual. In some embodiments, the additional agent for combined treatment or combined therapy increases, increases and / or promotes the efficacy and / or safety of the therapeutic effect of cell therapy, for example, projected T cell therapy, such as RAQ T cells *. In some embodiments, the additional agent increases or improves the effectiveness, survival or persistence of the administered cells, for example, recombinant receptor expression cells, for example, RAQRO.
[00698] [00698] In some embodiments, the additional therapy agent is an antibody or a cytotoxic or therapeutic agent, for example, a chemotherapeutic agent. In some embodiments, the one or more additional agents for treatment or therapy is an immunomodulatory agent, immune checkpoint inhibitor, adenosine pathway or adenosine receptor antagonist pathway or antagonist or agonist and kinase inhibitors. In some modalities, combined treatment or combined therapy includes additional treatment, such as surgical treatment, transplantation and / or radiation therapy.
[00699] [00699] In some embodiments, the additional agent is selected from a protein phosphatase inhibitor, a kinase inhibitor, a cytokine, an immunomodulator or an agent that decreases the level or activity of a regulatory T cell (Treg) In some embodiments , the additional agent increases safety by virtue of reducing or ameliorating the adverse effects of administered cell therapy. In some embodiments, the additional agent can treat the same disease, condition or comorbidity. In some embodiments, the additional agent may improve, reduce or eliminate one or more toxicities, adverse effects or side effects that are associated with the administration of the cells, for example, RAQ expression cells.
[00700] [00700] In some modalities, therapy, treatment or additional agent includes chemotherapy, radiation therapy, surgery, transplantation, cell therapy - adoptive, antibodies, cytotoxic agents, chemotherapeutic agents, cytokines, growth inhibiting agents, anti-hormonal agents, inhibitors kinase, antiangiogenic agents, - cardioprotective agents, immunostimulating agents, immunosuppressive agents, immune checkpoint inhibitors, antibiotics, angiogenesis inhibitors, metabolic modulators or other therapeutic agents or any combination thereof.
[00701] [00701] In some embodiments, the additional agent is a kinase inhibitor, for example, a Bruton tyrosine kinase (Btk) inhibitor, for example, ibrutinib. In some embodiments, the additional agent is an adenosine pathway or an adenosine receptor antagonist or agonist. In some embodiments, the additional agent is an immunomodulator, such as thalidomide or a thalidomide derivative (for example, lenalidomide). In some embodiments, the additional therapy, agent or treatment is a cytotoxic or chemotherapeutic agent, biological therapy (for example, antibody, for example, monoclonal antibody or cell therapy) or an inhibitor (for example, kinase inhibitor).
[00702] [00702] In some embodiments, the additional agent is a chemotherapeutic agent. Exemplary chemotherapeutic agents include an anthracycline (for example, doxorubicin, such as liposomal doxorubicin); an alkaloid vinca (for example, vinblastine, vincristine, vindesine, vinorelbine)) an alkylating agent (for example, cyclophosphamide, descarbazazine, melphalan, ifosfamide, temozolomide); an immune cell antibody (for example, aletuzamab, getuzumab, rituximab, tositumomab); an antimetabolite (including, for example, folic acid antagonists, pyrimidine analogs, purine analogs and adenosine deaminase inhibitors, such as fludarabine); a TNFR-related protein agonist (GITR) glucocorticoid-induced TNFR; a proteasome inhibitor (for example, —aclinomycin A, gliotoxin or Dbortezomib); an immunomodulator, such as thalidomide or a thalidomide derivative (for example, lenalidomide).
[00703] [00703] In some embodiments, the additional agent is an immunomodulatory agent. In some embodiments, the combination therapy includes an immunomodulatory agent that can stimulate, amplify and / or increase the anti-tumor immune response, for example, the anti-tumor immune response of the modified cells administered, such as inhibiting signaling - immunosuppressive “or improving immunostimulatory signaling. In some embodiments, the immunomodulatory agent is a peptide, protein, or small molecule. In some embodiments, the protein may be a fusion protein or a recombinant protein. In some embodiments, the immunomodulatory agent binds to an immunological target, such as a cell surface receptor expressed on immune cells, such as T cells, B cells or antigen presenting cells. For example, in some embodiments, the immunomodulatory agent is an antibody or antigen-binding antibody fragment, a fusion protein, a small molecule, or a polypeptide. In some embodiments, the binding molecules, recombinant receptors, cells and / or compositions are administered in combination with an additional agent which is an antibody or antigen-binding fragment thereof, such as a monoclonal antibody.
[00704] [00704] In some embodiments, the immunomodulating agent blocks, inhibits or neutralizes a component of the immune checkpoint pathway. The immune system has several inhibitory pathways involved in maintaining self-tolerance and in modulating immune responses. Tumors can use certain immune checkpoint pathways as a major mechanism of immune resistance, particularly against tumor antigen-specific T cells (Pardoll (2012) Nature Reviews Cancer 12: 252-264), for example, modified cells such as cells of RAQ expression. Since many of these immune checkpoints are initiated by ligand-receptor interactions, they can be easily blocked by antibodies against the ligands and / or their receptors. In contrast to most anticancer agents, checkpoint inhibitors do not necessarily target tumor cells directly, but rather lymphocyte receptors or their ligands, in order to increase the endogenous anti-tumor activity of the immune system.
[00705] [00705] In some embodiments, the additional agent is an immunomodulatory agent that is an antagonist molecule or is an immune checkpoint inhibitor capable of inhibiting or blocking a function of a molecule, or signaling pathway, involving a molecule of immune verification. In some embodiments, the molecule or immune checkpoint pathway is PD-1, PD-L1, PD-L2, CTLA-4, LAG-3, TIM3, VISTA, 2A adenosine receptor (A2AR) or adenosine or a pathway that involves any of the above. In certain embodiments, antagonistic molecules that block an immune checkpoint pathway, such as small molecules, nucleic acid inhibitors (eg, RNAi) or antibody molecules, are becoming promising avenues of immunotherapy for cancer and other diseases.
[00706] [00706] In some embodiments, the immune checkpoint inhibitor is a molecule that totally or partially reduces, inhibits, interferes with or modulates one or more checkpoint proteins. Checkpoint proteins regulate T cell activation or function. These proteins are responsible for co-stimulating or inhibitory interactions of T cell responses. Immune checkpoint proteins regulate and maintain self-tolerance and the duration and breadth of immune responses. physiological.
[00707] [00707] Immune checkpoint inhibitors include any agent that blocks or inhibits, in a statistically significant way, the inhibitory pathways of the immune system. Such inhibitors may include small molecule inhibitors or may include antibodies, or their antigen-binding fragments, which bind to and block or inhibit immune checkpoint receptors, ligands and / or receptor-ligand interaction. In some modalities, modulation, enhancement and / or stimulation of specific receptors can overcome components of the immune checkpoint pathway. Illustrative immune checkpoint molecules that can be targeted for blocking, inhibition, modulation, enhancement and / or stimulation include, but are not limited to, PD-1 (CD279), PD-L1 (CD274, B7-H1), PND2 (CD273, B7-DC), CTLA4, LAG-3 (CD223), TIM-3, 4-1BB (CD137), 4-1BBL (CD137L), GITR (TNFRSF18, AITR), CD40, OX40 (CD134, TNFRSF4) , CXCR2, tumor-associated antigens (TAA), B7-H3, B7-H4, BTLA, HVEM, GAL9, B7H3, B7H4, VISTA, KIR, 2B4 (belongs to the CD2 molecule family and is expressed in all NK, yô and memory CD8 * (aB) T cells, CD160 (also known as BY55), CGEN-15049, CEACAM (e.g. CEACAM-1, CEACAM-3 and / or CEACAM-5), TIGIT, LAIR1, CD160, 2B4, CD80, CD86, B7-H3 (CD276), B7-H4 (VTCN1), HVEM (TNFRSF14 or CD270), KIR, A2aR, MHC class |, MHC class Il, GAL9, adenosine and a transforming growth factor receptor (TGFR; for example, TGFR beta). Immune checkpoint inhibitors include antibodies, or their antigen-binding fragments, or other binding proteins, which bind to and block or inhibit and / or increase or stimulate the activity of one or more of said molecules.
[00708] [00708] Exemplary immune checkpoint inhibitors include Tremelimumab (CTLA-4 blocking antibody, also known as ticilimumab, CP-675.206), anti-OX40 monoclonal antibody, PD-L1 (Anti-B7-H1; MEDI4736), MK -3475 (PD 4 blocker), nivolumab (anti-PD-1 antibody), CT-011 (anti-PD-1 antibody), monoclonal antibody BY55, AMP224 (anti-PD-L1 antibody), BMS-936559 (anti- PD-L1 antibody), MPLDL3280A (anti-PD-L1 antibody), MSBOO10718C (anti-PD-L1 antibody) and ipilimumab (anti-CTLA-4 antibody, also known as Yervoy &, MDX-010 and MDX-101). Examples of immunomodulatory antibodies include, but are not limited to, Daclizumab (Zenapax)) Bevacizumab (Avastin O), Basiliximab, Ipilimumab, Nivolumab, Pembrolizumab, MPDL3280A, —Pidilizumabe (CT-011)) MK-3475, y BMSDel-936 , IMP321, BMS-986016, LAG525, urelumab, PF-05082566, TRX518, MK-4166, dacetuzumab (SGN-40), lucatumumab (HCD122), SEA-CD40, CP-870, CP-893, MEDG6A4, MEDI6383, MOXRO , AMP-224, MSBOO10718C (Avelumab), MEDI4736, - “PDROO01, rHIgM12B7, Ulocuplumab, BKT140, Varlilumab (CDX-1127), ARGX-110, MGA271, lirlumab (ARMX-110) 115, Emactuz2, Emactuz2 or an antibody-binding fragment thereof. Other exemplary immunomodulators include, for example, afutuzumab (available from RocheO); pegfilgrastim - (Neulasta &); lenalidomide (CC-5013, Revlimidê); thalidomide (ThalomidO), actimide (CC4047); and IRX-2 (mixture of human cytokines, including interleukin 1, interleukin 2 and interferon.gama., CAS 951209-71-5, available from IRX Therapeutics).
[00709] [00709] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent that binds and / or inhibits programmed cell death 1 (PD-1 ) PD-1 is an immune checkpoint protein that is expressed in B cells, NK cells and T cells (Shinohara et a /., 1995, Genomics 23: 704-6; Blank et a /., 2007, Cancer Immunol Immunother 56: 739-45; Finger et al., 1997, Gene 197: 177-87; Pardoll (2012) Nature Reviews Cancer 12: 252-264). The primary role of PD-1 is to limit the activity of T cells in peripheral tissues during inflammation in response to infection, as well as to limit autoimmunity. PD-1 expression is induced in activated T cells and binding of PD-1 to one of its endogenous ligands acts to inhibit T cell activation by inhibiting stimulatory kinases.
[00710] [00710] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent that binds or inhibits PD-L1 (also known as CD274 and B7 - H1) and / or PD-L2 (also known as CD273 and B7-DC). PD-L1 and PD-L2 are ligands for PD-1, found in activated T cells, B cells, myeloid cells, macrophages and some types of tumor cells. Anti-tumor therapies focused on anti-PD-L1 antibodies. The PD-1 and PD-L1 complex inhibits the proliferation of CD8 * T cells and reduces the immune response (Topalian et a /., 2012, N Engl J Med 366: 2443-54; Brahmer et al., 2012, N Eng J Med. 366: 2455-65). Anti-PD-L1 antibodies have been used to treat non-small cell lung cancer, melanoma, colorectal cancer, kidney cell cancer, pancreatic cancer, stomach cancer, ovarian cancer, breast cancer and haematological cancers ( Brahmer et al., 2012, N Eng J Med 366: 2455-65; Ott et a /., 2013, Clin Cancer Res 19: 5300-9; Radvanyi et al., 2013, Clin Cancer Res 19: 5541; Menzies & Long, 2013, Ther Adv Med Oncol 5: 278-85; Berger et al., 2008, Clin Cancer Res 14: 13044-51). Exemplary anti-PD-L1 antibodies include MDX-1105 (Medarex) MEDI4736 (Medimmune) MPDL3280A (Genentech), BMS-935559 (Bristol-Myers Squibb) and MSBO010718C. MEDI4736 (Medimmune) is a human monoclonal antibody that binds to PD-L1 and inhibits the interaction of the ligand with PD-1. MDPL3280A (Genentech / Roche) is an Fc-optimized human IgG1 monoclonal antibody that binds to PD-L1. MDPL3280A and other human monoclonal antibodies to PD-L1 are described in US Patent No. 7,943,743 and US Publication No. 20120039906. Other anti-PD-L1 binding agents include YW243.55.S870 (see WO 2010/077634 ) and MDX-1105 (also referred to as BMS-936559 and, for example, anti-PD-L1 binding agents described in WOZ2007 / 005874).
[00711] [00711] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent that is an inhibitor of the antigen associated with cytotoxic T lymphocytes (CTLA-4) , also known as CD152, or binds to CTLA4. CTLAA is a co-inhibitory molecule that works to regulate T cell activation. CTLA-4 is a member of the immunoglobulin superfamily that is expressed exclusively on T cells. CTLA-4 acts to inhibit T cell activation and is reported as inhibiting the activity of helper T cells and improving the immunosuppressive regulatory activity of T cells. Although the precise mechanism of action of CTLA-4 remains under investigation, it has been suggested that it inhibits T cell activation, bypassing CD28 in binding to CD80 and CD86, in addition to actively providing inhibitory signals to the T cell (Pardoll (2012) Nature Reviews Cancer 12: 252-264). Anti-CTLA- antibodies have been used in clinical trials for the treatment of melanoma, prostate cancer, small cell lung cancer, non-small cell lung cancer (Robert & Ghiringhelli, 2009, Oncologist 14: 848-61; Ott et a /., 2013, Clin Cancer Res 19: 5300; Weber, 2007, Oncologist 12: 864-72; Wada et al., 2013, J Trans! Med 11:89). A significant feature of anti-CTLA-4 is the kinetics of the antitumor effect, with a delay period of up to 6 months after the initial treatment necessary for the physiological response.
[00712] [00712] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent that binds and / or inhibits the lymphocyte activation gene-3 ( LAG-3), also known as CD223. LAG-3 is another immune checkpoint protein. LAG-3 has been associated with the inhibition of lymphocyte activity and, in some cases, with the induction of lymphocyte anergy. LAG-3 is expressed in several cells of the immune system, including B cells, NK cells and dendritic cells. LAG-3 is a natural ligand for the MHC class I receptor, which is substantially expressed in melanoma infiltrating T cells, including those with potent immunosuppressive activity. Exemplary anti-LAG-3 antibodies include BMS-986016 (Bristol-Myers Squib), which is a monoclonal antibody that targets LAG-3. IMP701 (Immutep) is an antagonist LAG-3 antibody and IMP731 (Immutep and GlaxoSmithKline) is a depleted LAG-3 antibody. Other inhibitors of LAG-3 include IMP321 (Immutep), which is a recombinant fusion protein of a soluble portion of LAG-3 and lg that binds to MHC class molecules | and activates antigen presenting cells (APC). Other antibodies are described, for example, in WO2010 / 019570 and US 2015/0259420.
[00713] [00713] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent that binds and / or inhibits the immunoglobulin domain of T cells and the domain -3 mucin (TIM-3). TIM-3 was initially identified in activated Th1 cells, proved to be a negative regulator of the immune response. TIM-3 blockade promotes T-cell-mediated antitumor immunity and has antitumor activity in several mouse tumor models. Combinations of TIM-3 blockade with other immunotherapeutic agents, such as TSR-042, anti-CD137 antibodies and others, can be additive or synergistic in increasing antitumor effects. TIM-3 expression has been associated with several different types of tumors, including melanoma, NSCLC and kidney cancer, in addition, intratumoral TIM-3 expression has shown correlation with poor prognosis in a variety of tumor types, including NSCLC, cervical , and gastric cancers. Blocking TIM-3 is also interested in promoting greater immunity to various chronic viral diseases. It has also been shown that TIM-3 interacts with several ligands, including galectin-9, phosphatidylserine and HMGB1, although which one, if any, is relevant in regulating antitumor responses, is not yet clear at the moment. In some embodiments, antibodies, antibody fragments, small molecules or peptide inhibitors that target TIM-3 can bind to the IgV domain of TIM-3 to inhibit interaction with its ligands. Exemplary antibodies and peptides that inhibit TIM-3 are described in US 2015/0218274, WO2013 / 006490 and US 2010/0247521. Other anti-TIM-3 antibodies include humanized versions of RMT3-23 (Ngiow et a / l., 2011, Cancer Res, 71: 3540- 3551) and clone 8B.2C12 (Monney et a /., 2002, Nature, 415: 536-541). Bispecific antibodies that inhibit TIM-3 and PD-1 are described in US 2013/0156774.
[00714] [00714] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent that is an inhibitor of CEACAM (for example, CEACAM-1, CEACAM- 3 and / or CEACAM-5 inhibitor). In some embodiments, the CEACAM inhibitor is an anti-CEACAM antibody molecule. Exemplary anti-CEACAM-1 antibodies are described in WO 2010/125571, WO 2013/082366 WO 2014/059251 and WO 2014/022332, for example, a monoclonal antibody 34B1, 26H7 and 5F4; or a recombinant form thereof, as described in, for example, US 2004/0047858, US 7,132,255 and WO 99/052552. In some embodiments, the anti-0CEACAM antibody binds to CEACAM-5 as described in, for example, Zheng et al. PLoS One. (2011) 6 (6): e21146), or cross reactions with CEACAM-1 and CEACAM-5, as described in, for example, WO 2013/054331 and US 2014/0271618.
[00715] [00715] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent that binds and / or inhibits 4-1BB, also known as CD137. 4-1BB is a transmembrane glycoprotein belonging to the TNFR superfamily. 4-1BB receptors are present on activated T cells and on B cells and monocytes. An exemplary anti-4-1BB antibody is urelumab (BMS-663513), which has potential immunostimulatory and antineoplastic activities.
[00716] [00716] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent that binds and / or inhibits the tumor necrosis factor receptor superfamily , member 4 (TNFRSF4), also known as OX40 and CD134. TNFRSFA4 is another member of the TNFR superfamily. OX40 is not constitutively expressed in naive T cells at rest and acts as a secondary co-stimulating immune checkpoint molecule. Exemplary anti-cOX40 antibodies are MEDI6469 and MOXRO0916 (RG7888, Genentech).
[00717] [00717] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent or a molecule that decreases the population of regulatory T cells (Treg). Methods that decrease the number of (e.g., deplete) Treg cells are known in the art and include, for example, CD25 depletion, administration of cyclophosphamide and modulation of the gene function related to the glucocorticoid-induced TNFR family (GITR). GITR is a member of the TNFR superfamily that is regulated in activated T cells, which improves the immune system. By reducing the number of Treg cells or apheresis or before the administration of modified cells, for example, RAQ expression cells, can reduce the number of unwanted immune cells (eg, Tregs) in the tumor microenvironment and reduce the risk of relapse of the individual. In some embodiments, the additional agent includes a molecule that targets GITR and / or modulates GITR functions, such as a GITR agonist and / or a GITR antibody that depletes regulatory T cells (Tregs). In some embodiments, the additional agent includes cyclophosphamide. In some embodiments, the GITR-binding molecule and / or the molecule-modulating GITR function (eg, GITR agonist and / or Treg-depleting GITR antibodies) is administered before the modified cells, eg, RAQ expression cells . For example, in some embodiments, the GITR agonist can be administered prior to cell apheresis. In some embodiments, cyclophosphamide is administered to the individual prior to administration (for example,
[00718] [00718] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent that is a GITR agonist. Exemplary GITR agonists include, for example, GITR fusion proteins and anti-GITR antibodies (e.g., divalent anti-GITR antibodies), such as, for example, a GITR fusion protein described in US Patent No. 6,111,090, Patent European No. 090505B 1, US Patent 8,586,023, PCT Publications: WO 2010/003118 and 2011/090754, or an anti-GITR antibody described, for example, in US Patent No. 7,025,962, European Patent No. 1947183B 1 , US Patent No. 7,812,135, US Patent 8,388,967, US Patent No. 8,591,886, European Patent No. EP 1866339, PCT Publication No. WO 2011/028683, PCT Publication No. WO 2013/039954, PCT Publication No. WOZ2005 / 007190, PCT Publication No. WO 2007/133822, PCT Publication No. WO2005 / 055808, PCT Publication No. WO 99/40196, PCT Publication No. WO 2001/03720, PCT Publication No. WO99 / 20758, PCT Publication No. WO2006 / 083289, PCT Publication No. WO 2005/115451, US Patent No. 7,618,632 and PCT Publication No. WO 2011/051726. An exemplary anti-GITR antibody is TRX518.
[00719] [00719] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, improves tumor infiltration or transmigration of the administered cells, for example,
[00720] [00720] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an immunomodulatory agent that is a structural or functional analog or derived from thalidomide and / or a E3 ubiquitin ligase inhibitor. In some modalities, the immunomodulatory agent binds to the cereblon (CRBN). In some embodiments, the immunomodulatory agent binds to the CRBN E3 ubiquitin ligase complex. In some embodiments, the immunomodulatory agent binds to CRBN and the CRBN E3 ubiquitin ligase complex. In some embodiments, the immunomodulatory agent upregulates the expression of CRBN proteins or genes. In some respects, CRBN is the substrate adapter for the ubiquitin ligase CRLA4CRBN E3 and modulates the specificity of the enzyme. In some embodiments, binding to CRB or the CRBN complex E3 ubiquitin ligase inhibits the activity of E3 ubiquitin ligase In some embodiments, the immunomodulatory agent induces the ubiquination of KZF1 (lkaros) and IKZF3
[00721] [00721] In some embodiments, the immunomodulatory agent is an inhibitor of the lkaros transcription factor (IKZF1) In some embodiments, the immunomodulatory agent improves the omnipresence of lkaros. In some embodiments, the immunomodulatory agent improves the degradation of lkaros. In some embodiments, the immunomodulatory agent down-regulates the expression of proteins or genes of lkaros. In some embodiments, administration of the immunomodulatory agent causes a decrease in lkaros protein levels.
[00722] [00722] In some embodiments, the immunomodulatory agent is an inhibitor of the Aiolos transcription factor (IKZF3) In some embodiments, the immunomodulatory agent improves the ubiquitination of Aiolos. In some embodiments, the immunomodulating agent improves the breakdown of Aiolos. In some embodiments, the immunomodulatory agent down-regulates the expression of Aiolos proteins or genes. In some embodiments, administration of the immunomodulatory agent causes a decrease in the levels of Aiolos protein.
[00723] [00723] In some embodiments, the immunomodulatory agent is an inhibitor of the transcription factors Ikaros (IKZF1) and Aiolos (IKZF3). In some - modalities, the immunomodulating agent improves the ubiquitination of Ilkaros and Aiolos. In some embodiments, the immunomodulatory agent improves the degradation of lkaros and Aiolos. In some - modalities, the immunomodulatory agent improves the ubiquitination and degradation of lkaros and Aiolos. In some embodiments, the administration of the immunomodulatory agent causes the levels of Aiolos protein and lkaros protein levels to decrease.
[00724] [00724] In some embodiments, the immunomodulatory agent is a selective cytokine inhibiting drug (SelClID) In some embodiments, the immunomodulatory agent inhibits phosphodiesterase-4 (PDE4) activity. In some embodiments, the immunomodulatory agent suppresses the enzymatic activity of CDC25 phosphatases. In some embodiments, the immunomodulatory agent alters the intracellular traffic of CDC25 phosphatases.
[00725] [00725] In some embodiments, the immunomodulatory agent is thalidomide (2- (2,6-dioxopiperidin-3-yl) -1H-isoindol-1,3 (2H) -dione) or an analog or derivative of thalidomide. In certain embodiments, a thalidomide derivative includes structural variants of thalidomide that have similar biological activity. Examples of thalidomide derivatives include, but are not limited to, lenalidomide (REVLIMMUNOMODULATORY COMPOUNDY; Celgene Corporation), pomalidomide (also known as ACTIMMUNOMODULATORY COMPOUND '"" or POMALYST' "Y (Celgene Corporation)), CC-1088, CDC-501 and CDC- 501 501 and CDC-501 and the compounds described in U.S. Pat. 5,712,291; 7,320,991; and 8,716,315; US Appl. No. 2016/0313300; and PCT Pub. WO 2002/068414 and WO 2008/154252.
[00726] [00726] In some embodiments, the immunomodulatory agent is 1 - oxo-e 1,3 dioxo-2- (2,6-dioxopiperldin-3-yl) isoindolines substituted by amino in the benzo ring, as described in US Patent 5,635,517 , which is incorporated by reference.
[00727] [00727] In some embodiments, the immunomodulatory agent is a compound of the following formula: O, AX, R $ NH HoN where one of X and Y is -C (O) - and the other of X and Y is -C ( O) - or -CH7-, and
[00728] [00728] In some embodiments, the immunomodulatory compound is a compound that belongs to a class of 2- (2, 6-dioxopiperidin-3-yl) phthalimunomodulatory - substituted and 2- (2,6-dioxopiperldin-3-yl) compounds - 1-substituted oxoisoindols, such as those described in US Patent 6,281,230; 6,316,471; 6,335,349; and 6,476,052, and International Patent Application No. - PCT / US97 / 13375 (International Publication No. WO 98/03502), each of which is incorporated herein by reference.
[00729] [00729] In some embodiments, the immunomodulatory agent is a compound of the following formula: R o ot N o R: Y Rº where one of X and Y is -C (O) - and the other of X and Y is -C (O) - or -CH> 2-; (1) each of R ', Rº, Rº and Rº is independently halo, alkyl of 1 to 4 carbon atoms or alkoxy or 1 to 4 carbon atoms, or (2) one of R', Rà, Rº and Rº is -NHRº and the remainder of R ', Rà, Re Rº is hydrogen, where Rº is hydrogen or alkyl of 1 to 8 carbon atoms; Rº is hydrogen or alkyl of 1 to 8 carbon atoms, benzyl or halo; provided that R * is different from hydrogen if X and Y are -C (O) - and (i) each of R ', R , Rº and Rº is fluoro; or (ii) one of R ', R , Re Rº for amino; or its pharmaceutically acceptable salt.
[00730] [00730] In some embodiments, the immunomodulatory agent is a compound "that belongs to a class of isoindole immunomodulatory compounds described in US Patent 7,091,353, U.S. Patent Publication
[00731] [00731] In some embodiments, the immunomodulatory agent is a compound "that belongs to a class of isoindole immunomodulatory compounds described in U.S. Patent Application Publications Nos. 2002/0045643, International Publication No. WO 98/54170 and US Patent 6,395,754, each of which is incorporated herein by reference. In some embodiments, the immunomodulatory agent is a 2- (2,6-dioxopiperdin-3-yl) Tetra-substituted -1-oxoisoindolines described in US Patent 5,798,368, which is incorporated herein by reference. In some embodiments, the immunomodulatory agent is 1- oxo and 1,3-dioxo-2- (2,6-dioxopiperidin-3- iNisoindolines described in US Patent 6,403,613, which is hereby incorporated by reference. In some embodiments, the immunomodulatory agent is a 1-0x0 or 1,3-dioxoisoindoline substituted at the 4- or 5 position of the indoline ring, as described in US Patent
[00732] [00732] In some embodiments, the immunomodulating agent is —2- (4-amino-1-0x0-1,3-dihydro-isoindol-2-yl) -4-carbamoyl-butyric acid or 4- (4-amino-1-0x0-1,3-dihydro-isoindol-2-yl) -4-carbamoyl-butyric. In some embodiments, the immunomodulatory compound is 4-carbamoyl-4-f4 - [(furan-2-yl-methyl) -amino] -1,3-dioxo-1,3-dihydro-isoindol-2-yl acid ) -butyric, 4-carbamoyl-2-f4 - [(furan-2-yl-methyl) -amino] - 1,3-dioxo-1,3-dihydro-isoindol-2-yl) -butyric acid, - 2-f4 - [(furan-2-yl-methyl) -amino] -1,3-dioxo-1,3-dihydro-isoindol-2-yl) -4-phenylcarbamoyl-butyric or 2- f4- [(furan-2-yl-methyl) -amino] -1,3-dioxo-1,3-dihydro-isoindol-2-yl) -pentanedioic acid.
[00733] [00733] In some embodiments, the immunomodulatory agent is an isoindoline-1-one or isoindoline-1,3-dione substituted in position 2 by 2,6-dioxo-3-hydroxypiperidin-S5-yl, as described in the US Patent. No. 6,458,810, which is incorporated herein by reference. In some embodiments, the immunomodulatory compound is 3- (5-amino-2-methyl-4-0x0- 4H-quinazolin-3-yl) -piperidine-2,6-dione, or an enantiomer or a mixture of enantiomers thereof ; or its pharmaceutically acceptable salt, solvate, hydrate, cocrystal, clathrate or polymorph. In some embodiments, the immunomodulatory compound is 3- [4- (4-morpholin-4-ylmethyl-benzyloxy) -1-0x0-1,3-dihydro-isoindol-2-yl] -piperidine-2,6- diona.
[00734] [00734] In some embodiments, the immunomodulatory agent is as described in Oshima, K. et al., Nihon Rinsho., 72 (6): 1130-5 (2014); Millrine, D. et a /., Trends Mol Med., 23 (4): 348-364 (2017), and Collins et a /., Biochem J., 474 (7): 1127-1147 (2017).
[00735] [00735] In some embodiments, the immunomodulating agent is lenalidomide, pomalidomide, avadomide, a stereoisomer of lenalidomide, pomalidomide, avadomide or a pharmaceutically acceptable salt, solvate, hydrate, cocrystal, clathrate or polymorph. In some embodiments, the immunomodulatory compound is lenalidomide, a stereoisomer of lenalidomide or a pharmaceutically acceptable salt, solvate, hydrate, cocrystal, clathrate or polymorph. In some embodiments, the immunomodulatory compound is lenalidomide or ((RS) -3- (4-Amino-1-0x0-1,3-dihydro-2H-isoindol-2-yl) piperidine-2,6-dione) .
[00736] [00736] In some embodiments, the additional agent includes drugs from thalidomide or its analogs and / or its derivatives, such as lenalidomide, pomalidomide or apremilast. See, for example, Bertilaccio et al, Blood (2013) 122: 4171, Otahal et al, Oncoimmunology (2016) 5 (4): e1115940; Fecteau et al., Blood (2014) 124 (10): 1637-1644 and Kuramitsu et a /., Cancer Gene Therapy (2015) 22: 487-495). Lenalidomide ((RS) -3- (4-amino-1-0x0-1,3-dihydro-2H-isoindol-2-yl) piperidine-2,6-dione; also known as Revlimide) is a derivative synthetic of thalidomide and has multiple immunomodulatory effects, including the imposition of the formation of immune synapses between T cells and antigen presenting cells (APCs). For example, in some cases, lenalidomide modulates T cell responses and results in increased production of interleukin (IL) -2 in CD4 * and CD8 ”* T cells, inducing displacement of T helper (Th) responses from Th2 to Th1, inhibits the expansion of the regulatory subset of T cells (Tregs) and improves the functioning of immune synapses in follicular lymphoma and chronic lymphocytic leukemia (LLC) (Otahal et al, Oncoimmunology (2016) 5 (4): e1115940). Lenalidomide also has direct tumoricidal activity in patients with multiple myeloma (MM) and directly and indirectly modulates the survival of CLL tumor cells, affecting support cells, such as nurse-like cells found in the lymphoid tissue microenvironment. Lenalidomide can also increase the proliferation of T cells and the production of interferon-y in response to activation of T cells through CD3 binding or activation mediated by dendritic cells. Lenalidomide can also induce malignant B cells to express higher levels of immunostimulatory molecules, such as CD80, CD86, HLA-DR, CD95 and CD40 (Fecteau et al., Blood (2014) 124 (10): 1637-1644). In some embodiments, lenalidomide is administered in a dosage of about | mg to about 20 mg per day, for example, from about 1 mg to about 10 mg, from about 2.5 mg to about 7.5 mg, from about 5 mg to about 15 mg, such like about 5 mg, 10 mg, 15 mg or mg per day. In some embodiments, lenalidomide is administered at a dose of about 10 µg / kg to 5 mg / kg, for example, about 100 µg / kg to about 2 mg / kg, about 200 µg / kg to about 1 mg / kg, about 400 µg / kg to about 600 µg / Kkg, such as about 500 µg / Kkg.
[00737] [00737] In some embodiments, the additional agent that is administered according to the methods provided, and / or the articles of manufacture or compositions provided, is a B cell inhibitor. In some embodiments, the additional agent is one or more B cell inhibitors selected from CD10, CD19, CD20, CD22, CD34, CD123, CD79a, CD79b, CD179b, FLT-3 or RORI1 inhibitors or a combination thereof. In some embodiments, the B cell inhibitor is an antibody (for example, a mono- or bispecific antibody) or an antigen-binding fragment thereof. In some embodiments, the additional agent is a modified cell that expresses recombinant receptors that targets B cell targets, for example, CD10, CD19, CD20, CD22, CD22, CD34, CD123, CD79a, CD79b, CD179b, FLT-3 or ROR1 .
[00738] [00738] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is a CD20 inhibitor, for example, an anti-CD20 antibody (for example, a mono or bispecific anti-CD20 antibody) or a fragment thereof. Exemplary anti-CD20 antibodies include, but are not limited to, rituximab, ofatumumab, ocrelizumab (also known as GA101 or RO5072759), veltuzumab, obinutuzumab, TRU-015 (Trubion Pharmaceuticals), ocaratuzumab (also known as AME-133v or ocaratuzumabe (Pro13 Genent21) ). See, for example, Lim et al. Haematologica. (2010) 95 (1): 135-43. In some embodiments, the anti-cCD20 antibody comprises rituximab. Rituimab is an antibody — chimeric mouse / human IgG1 kappa monoclonal antibody that binds to CD20 and causes cytolysis of a cell that expresses CD20. In some embodiments, the additional agent includes rituximab. In some embodiments, the CD20 inhibitor is a small molecule.
[00739] [00739] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is a CD22 inhibitor, for example, an anti-CD22 antibody (for example, a mono or bispecific anti-CD22 antibody) or fragment thereof. Exemplary anti-CD22 antibodies include epratuzumab and RFB4. In some embodiments, the CD22 inhibitor is a small molecule. In some embodiments, the antibody is a monospecific antibody, optionally conjugated to a second agent, such as a chemotherapeutic agent. For example, in some embodiments, the antibody is an anti-CD22-MMAE monoclonal antibody conjugate (for example, DCDT2980S). In some embodiments, the antibody is an scFv of an anti-CD22 antibody, for example, an scFv of the RFB4 antibody. In some embodiments, scFv is fused to all or a fragment of Pseudomonas exotoxin-A (eg, BL22) In some embodiments, scFv is fused to all or a fragment of (eg, a 38 kDa fragment of ) Pseudomonas exotoxin-A (for example, moxetumomab pasudotox). In some embodiments, the anti-CD22 antibody is a bispecific anti-CD19 / CD22 antibody, optionally conjugated to a toxin. For example, in some embodiments, the anti-cCD22 antibody comprises a bispecific anti-CD19 / CD22 portion (e.g., two scFv linkers, recognizing human CD19 and CD22) optionally linked to all or a portion of the diphtheria toxin (DT), for example, first 389 amino acids of diphtheria toxin (DT), DT 390, for example, a ligand-directed toxin, such as DT2219ARL) In some embodiments, the bispecific portion (for example, anti-CD19 / anti-CD22) is linked to a toxin such as deglycosylated ricin A chain (for example, Combotox).
[00740] [00740] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is a cytokine or is an agent that induces increased expression of a cytokine in the tumor microenvironment . Cytokines have important functions related to the expansion, differentiation, survival and homeostasis of T cells. Cytokines that can be administered to the individual receiving combination therapy in the methods or uses provided, recombinant receptors, cells and / or compositions provided herein include one or more than IL-2, IL-4, IL-7, IL-9, IL-15, 11-18 and 11-21. In some embodiments, the cytokine administered is IL-7, IL-15 or IL-21, or a combination thereof. In some embodiments, administration of the cytokine to the individual who has a suboptimal response to administration of the modified cells, for example, RAQ expression cells improves the efficacy and / or anti-tumor activity of the administered cells, for example, RAQ expression cells.
[00741] [00741] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is a cytokine, as a protein that acts in another cell as intercellular mediators. Examples of such cytokines are lymphokines, monocytes and traditional polypeptide hormones. Cytokines include growth hormones, such as human growth hormone, N-methionyl human growth hormone and bovine growth hormone; parathyroid hormone; thyroxine; insulin; proinsulin; relaxin; prorelaxin; glycoprotein hormones such as follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH) and luteinizing hormone (LH); liver growth factor; fibroblast growth factor; prolactin; placental lactogen; tumor necrosis factor alpha and beta; Mullerian inhibiting substance; mouse gonadotropin-associated peptide; inhibin; activin; vascular endothelial growth factor; integrin; thrombopoietin (TPO); nerve growth factors like NGF-
[00742] [00742] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, includes an interleukin-15 polypeptide (IL-15), an alpha receptor polypeptide of interleukin-15 (IL-15Ra), or a combination thereof, for example, hetll-15 (Admune Therapeutics, LLC). hetll-15 is a non-covalent heterodimeric complex of IL-15 and IL-15Ra. hetlL-15 is described in, for example, U.S. 8,124,084, U.S. 2012/0177598, U.S. 2009/0082299, U.S. 2012/0141413 and U.S. 2011/0081311. In some embodiments, the immunomodulatory agent may contain one or more cytokines. For example, interleukin may include leukocyte interleukin injection (Multikine), which is a combination of natural cytokines.
[00743] [00743] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is a modulator of the levels of adenosine and / or a component of the adenosine pathway.
[00744] [00744] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent that inhibits the activity and / or an amount of an adenosine receptor. Particular modalities contemplate that the inhibition or reduction of extracellular adenosine or the adenosine receptor due to an inhibitor of extracellular adenosine (as an agent that prevents the formation, degrades, makes inactive and / or decreases extracellular adenosine) and / or an o adenosine receptor inhibitor (as an adenosine receptor antagonist) can improve the immune response, such as macrophages, neutrophils, granulocytes, dendritic cells, T-cell and / or B-mediated response. In addition, inhibitors of the intracellular pathway dependent on cAMP mediated by Gs protein and inhibitors of intracellular pathways mediated by Gi protein triggered by the adenosine receptor, can also increase acute and chronic inflammation.
[00745] [00745] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an adenosine receptor antagonist or agonist, for example, an antagonist or agonist of a or more of the adenosine receptors A2a, A2b, A1 and A3. A1 and A3 inhibit, and A2a and A2b stimulate the activity of adenylate cyclase, respectively. Certain adenosine receptors, such as A2a, A2b and A3, can suppress or reduce the immune response during inflammation. Thus, antagonizing immunosuppressive adenosine receptors can increase, enhance or improve the immune response, for example, immune response of administered cells, for example, RAQ expression T cells. In some embodiments, the additional agent inhibits the production of extracellular adenosine and signaling triggered by adenosine through adenosine receptors. For example, enhancing an immune response, local tissue inflammation and targeted tissue destruction can be enhanced by inhibiting or reducing the local hypoxia of adenosine-producing tissue; degrading (or rendering inactive) the accumulated extracellular adenosine; preventing or decreasing the expression of adenosine receptors in immune cells; and / or inhibiting / antagonizing signaling by adenosine ligands through adenosine receptors.
[00746] [00746] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an adenosine receptor antagonist. In some embodiments, the antagonist is a small molecule or chemical compound of an adenosine receptor, such as the A2a, A2b or A3 receptor. In some embodiments, the antagonist is a peptide, or peptidomimetic, that binds to the adenosine receptor, but does not trigger an intracellular pathway dependent on the Gi protein. Examples of such antagonists are described in U.S. Pat. 5,565,566; 5,545, 627, 5,981,524; 5,861,405;
[00747] [00747] In some embodiments, the additional agent is an A2 receptor antagonist (A2R), like an A2a antagonist. Exemplary A2R antagonists include, but are not limited to, KWB600 (istradefyline), SCH58261, caffeine, paraxanthin, 3,7-dimethyl-1-propargylxanthin (DMPX), 8- (m-chlorostylyl) caffeine (CSC), MSX-2, MSX-3, MSX4, CGS-15943, ZM -241385, SCH-442416, preladenant, vipadenant (BlIO14) V2006, ST-1535, SYN-115, PSB-1115, ZM241365, FSPTP and an acid-inhibiting A2R expression nucleus, for example, siRNA or shRNA, or any antibody or its antigen-binding fragment targeting an A2R. In some embodiments, the additional agent is an A2R antagonist described in, for example, Ohta et al., Proc Nat! Acad Sci USA (2006) 103: 13132-13137; Jin et al., Cancer Res. (2010) 70 (6): 2245-2255; Leone et al., Computational and Structural Biotechnology Journal (2015) 13: 265-272; Beavis et al /., Proc Natl Acad Sci USA (2013) 110: 14711-14716; and Pinna, A., Expert Opin Investig Drugs (2009) 18: 1619-1631; Sitkovsky et al., Cancer Immunol Res (2014) 2 (7): 598-605; US 8,080,554; US 8,716,301; US 20140056922; WO2008 / 147482; US 8,883,500; US 20140377240; WO02 / 055083; US 7,141,575; US 7,405,219; US 8,883,500; US
[00748] [00748] In particular embodiments, an adenosine receptor antagonist which is an antisense molecule, inhibitory nucleic acid molecule (eg small inhibitory RNA (siRNA)) or catalytic nucleic acid molecule (eg a ribozyme) specifically binds to mMRNA encoding an adenosine receptor. In some embodiments, the antisense molecule, nucleic acid inhibiting molecule or catalytic nucleic acid molecule binds to nucleic acids encoding A2a, A2b or A3. In some embodiments, an antisense molecule, nucleic acid inhibiting molecule or catalytic nucleic acid directs biochemical pathways downstream of the adenosine receptor. For example, the antisense molecule or catalytic nucleic acid can inhibit an enzyme involved in the Gs or Gi protein dependent intracellular pathway. In some embodiments, the additional agent includes the dominant negative mutant form of an adenosine receptor, such as A2a, A2b or A3.
[00749] [00749] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is an agent that inhibits extracellular adenosine. Agents that inhibit extracellular adenosine include agents that make extracellular adenosine non-functional (or diminish that function), such as a substance that modifies the structure of adenosine to inhibit adenosine's ability to signal through adenosine receptors. In some embodiments, the additional agent is an adenosine-generating or degrading extracellular enzyme, a modified form of it or a modulator of it. For example, in some embodiments, the additional agent is an enzyme (for example, adenosine deaminase) or another catalytic molecule that selectively binds and destroys adenosine, abolishing or significantly decreasing = the ability of endogenously formed adenosine to signal through receptors of adenosine and end inflammation.
[00750] [00750] In some embodiments, the additional agent is an adenosine deaminase (ADA) or a modified form thereof, for example, recombinant ADA and / or ADA modified with polyethylene glycol (ADA-PEG), which can inhibit the accumulation of adenosine extracellular tissue in the local tissue. ADA-PEG was used to treat patients with ADA SCID (Hershfield (1995) Hum Mutat. 5: 107). In some embodiments, an agent that inhibits extracellular adenosine includes agents that prevent or decrease the formation of extracellular adenosine and / or prevent or decrease the accumulation of extracellular adenosine, substantially abolishing or decreasing the immunosuppressive effects of adenosine. In some embodiments, the additional agent specifically inhibits enzymes and proteins involved in regulating the synthesis and / or secretion of pro-inflammatory molecules, including modulators of nuclear transcription factors. Suppression of adenosine receptor expression or expression of the Gs or Gi protein-dependent intracellular pathway or cAMP-dependent intracellular pathway can result in an increase / enhancement of the immune response.
[00751] [00751] In some embodiments, the additional agent may target ectoenzymes that generate or produce extracellular adenosine. In some embodiments, the additional agent targets the CD39 and CD73 ectoenzymes, which work together to generate extracellular adenosine. CD39 (also called diphosphohydrolase ectonucleoside triphosphate) converts extracellular ATP (or ADP) into 5'AMP. Subsequently, CD73 (also called B'nucleotidase) converts S'AMP to adenosine. CD39 activity is reversible by the actions of NDP kinase and adenylate kinase, while CD73 activity is irreversible. CD39 and CD73 are expressed in tumor stromal cells, including endothelial cells and Tregs, and also in many cancer cells. For example, CD39 expression in ndothelial cells is increased in the hypoxic conditions of the tumor microenvironment. Tumor hypoxia can result from inadequate blood supply and the tumor's disorganized vasculature, impairing oxygen supply (Carroll and Ashcroft (2005), Expert. Rev. Mol. Med. 7 (6): 1 - 16). Hypoxia also inhibits adenylate kinase (AK), which converts adenosine to AMP, leading to a very high extracellular concentration of extracellular adenosine. Thus, adenosine is released in high concentrations in response to hypoxia, a condition that occurs frequently in the tumor microenvironment (TME), in or around solid tumors. In some embodiments, the additional agent is one or more anti-CD39 antibody or its antigen-binding fragment, anti-CD73 antibody or its antigen-binding fragment, for example, MEDI9447 or TY / 23, aB-methylene-diphosphate adenosine (ADP), ARL 67156, POM-3, IPH52 (see, for example, Allard et al. Clin Cancer Res (2013) 19 (20): 5626- 5635; Hausler et al., Am J Transl Res (2014) 6 (2): 129-139; Zhang, B., Cancer Res. (2010) 70 (16): 6407-6411).
[00752] [00752] In some embodiments, the additional agent that is administered according to the methods provided and / or the articles of manufacture or compositions provided, is a chemotherapeutic agent (sometimes called a cytotoxic agent). In particular embodiments, the chemotherapeutic agent is any agent known to those skilled in the art as being effective for the treatment, prevention or improvement of hyperproliferative disorders, such as cancer. Chemotherapeutic agents include, but are not limited to, small molecules, synthetic drugs, peptides, polypeptides, proteins, nucleic acids (for example, DNA and RNA polynucleotides, including, but not limited to, antisense nucleotide sequences, triple helices and nucleotide sequences that encode biologically active proteins, polypeptides or peptides), antibodies, synthetic or natural inorganic molecules, mimetic agents and synthetic or natural organic molecules. In particular embodiments, chemotherapeutic drugs include alkylating agents, anthracyclines, cytoskeletal disruptors (taxanes), epothilones, histone deacetylase inhibitors, topoisomerase inhibitors, topoisomerase 1l inhibitors, kinase inhibitors, nucleotide analogs and precursor antibiotics, peptide antibiotics , agents based on platinum and vinca alkaloids and derivatives.
[00753] [00753] Chemotherapeutic agents may include, but are not limited to, abarelix, aldesleukin, aletuzumab, alitretinoin, allopurinol, altretamine, amifostine, anastrozole, arsenic trioxide, asparaginase, live BCG, bevaceizumab, bromothromine, bromothromine, boroxine, bromothromine, bleomycin, camptothecin, capecitabine, carboplatin, carmustine, celecoxib, cetuximab, chlorambucil, cinacalcet, —cisplatinay cladribinay cyclophosphamide, cytarabine, dacarbazine, dactinomycin, darbepoetin alfa, docunoxyxine, daunorxazine, dynorxoxine, dynoroxyxine, dynoroxyxine, dinunorxine
[00754] [00754] In some embodiments, the additional agent is an inhibitor of hypoxia-inducible factor 1 alpha (HIF-10) signaling. Exemplary HIF-1a inhibitors include digoxin, acriflavin, sirtuin-7 and ganetespib.
[00755] [00755] In some embodiments, the additional agent includes a protein tyrosine phosphatase inhibitor, for example, a protein tyrosine phosphatase inhibitor described here. In some embodiments, the protein tyrosine phosphatase inhibitor is an inhibitor of SHP-1, for example, an inhibitor of SHP-1 described herein, such as, for example, sodium stibogliconate. In some embodiments, the protein tyrosine phosphatase inhibitor is an SHP-2 inhibitor, for example, an SHP-2 inhibitor described herein.
[00756] [00756] In some embodiments, the additional agent is a kinase inhibitor. Kinase inhibitors, such as a CDKA4 kinase inhibitor, a BTK kinase inhibitor, an MNK kinase inhibitor or a DGK kinase inhibitor, can regulate the constitutively active survival pathways that exist in tumor cells and / or modulate the function of immune cells. In some embodiments, the kinase inhibitor is a Bruton tyrosine kinase (BTK) inhibitor, for example, ibrutinib. In some embodiments, the kinase inhibitor is a phosphatidylinositol-4,5-bisphosphate 3-kinase (PISK) inhibitor. In some embodiments, the kinase inhibitor is a CDKA inhibitor, for example, a CDK4 / 6 inhibitor. In some embodiments, the kinase inhibitor is an MTOR inhibitor, such as, for example, rapamycin, a rapamycin analogue, OSI-027. The MTOR inhibitor can be, for example, an MTORC1 inhibitor and / or an MTORCβ2 inhibitor, for example, an MTORC1 inhibitor and / or MTORC2 inhibitor. In some embodiments, the kinase inhibitor is an MNK inhibitor or a dual PISK / MTOR inhibitor. In some embodiments, other exemplary kinase inhibitors include the AKT inhibitor, the mMTOR inhibitor temsirolimus, the Src kinase inhibitors dasatinib and fostamatinib, the JAK2 inhibitors pacritinib and ruxolitinib, the PKCB inhibitors, enzastaurine and brost AAKibe inhibitor.
[00757] [00757] In some embodiments, the kinase inhibitor is a BTK inhibitor selected from ibrutinib (PClI-32765); GDC-0834; RN- 486; CGI-560; CGI-1764; HM-71224; CC-292; ONO-4059; CNX-774; and LFM-A13. In some embodiments, the BTK inhibitor does not reduce or inhibit interleukin-2-inducible kinase (ITK) kinase activity and is selected from GDC-0834; RN-486; CGI-560; CGl1-1764; HM-71224; CC-292; ONO-4059; CNX-774; and LFEM-A13.
[00758] [00758] In some embodiments, the kinase inhibitor is a BTK inhibitor, for example, ibrutinib (1 - [(3R) -3- [4-Amino-3- (4-phenoxyphenyl) -
[00759] [00759] In some embodiments, the kinase inhibitor is a PISK inhibitor. PISK is central to the PISK / AKVYVMTOR pathway involved in the regulation of the cell cycle and lymphoma survival. Exemplary PI3K inhibitor includes idelalisib (PI3K5 inhibitor). In some embodiments, the additional agent is idelalisib and rituximab.
[00760] [00760] In some embodiments, the additional agent is an inhibitor of the rapamycin mammalian target (MTOR). In some embodiments, the kinase inhibitor is an MTOR inhibitor selected from temsirolimus; ridaforolimus (also known as AP23573 and MK8669); everolimus (RADOO01); rapamycin (AY22989); simapimod; AZD8055; PFO4691502; SF1126; and XL765. In some embodiments, the additional agent is an inhibitor of mitogen-activated protein kinase (MAPK), such as vemurafenib, dabrafenib and trametinib.
[00761] [00761] In some embodiments, the additional agent is an agent that regulates pro or anti-apoptotic proteins. In some embodiments, the additional agent includes a B 2 cell lymphoma (BCL-2) inhibitor (eg, venetoclax, also called ABT-
[00762] [00762] In some embodiments, the additional agent includes a cytotoxic agent, for example, CPX-351 (Celator Pharmaceuticals), cytarabine, daunorubicin, vosaroxin (Sunesis Pharmacetuticals), sapacitabine (Cyclacel Pharmaceuticals), idarubicin, or mitoxantrone. In some embodiments, the additional agent includes a hypomethylating agent, for example, a DNA methyltransferase inhibitor, for example, azacytidine or decitabine.
[00763] [00763] In another modality, the additional therapy is a transplant, for example, allogeneic stem cell transplantation.
[00764] [00764] In some modalities, additional therapy is a therapy that causes lymphodeficiency. In some embodiments, lymphodepletion is performed on an individual, for example, before the administration of modified cells, for example, RAQ expression cells. In some modalities, lymphodepletion comprises the administration of one or more among melphalan, cytoxan, cyclophosphamide and fludarabine. In some embodiments, a lymphodeplective chemotherapy is administered to the individual before, simultaneously, or after the administration (for example, infusion) of modified cells, for example, RAQ expression cells. In one example, chemotherapy that destroys lymph is administered to the individual prior to administration of modified cells, for example, RAQ expression cells.
[00765] [00765] In some embodiments, the additional agent is an oncolytic virus. In some embodiments, oncolytic viruses are able to selectively replicate and trigger death or slow the growth of a cancer cell. In some cases, oncolytic viruses have no effect or minimal effect on non-cancerous cells. An oncolytic virus includes, but is not limited to, oncolytic adenovirus, herpes simplex oncolytic virus, oncolytic retrovirus, oncolytic parvovirus, oncolytic vaccine virus, oncolytic Sinbis virus, oncolytic influenza virus or oncolytic RNA virus (eg oncolytic reovirus, (NDV), measles oncolitic virus or oncolitic vesicular stomatitis virus (VSV)).
[00766] [00766] Other combination therapies, treatments and / or exemplary agents include antiallergic, antiemetic, analgesic and adjuvant therapies. In some embodiments, the additional agent includes cytoprotective agents, such as neuroprotectors, free radical scavengers, cardioprotectors, anthracycline leakage neutralizers and nutrients.
[00767] [00767] In some embodiments, an antibody used as an additional agent is conjugated or otherwise linked to a therapeutic agent, for example, a chemotherapeutic agent (for example, Cytoxan, fludarabine, histone deacetylase inhibitor, demethylating agent, vaccine peptide, antitumor antibiotic, tyrosine kinase inhibitor, alkylating agent, antimicotubule or antimitotic agent), antiallergic agent, antinusea (or antiemetic) agent, analgesic or cytoprotective agent described here. In some embodiments, the additional agent is an antibody-drug conjugate.
[00768] [00768] Any of the additional agents described in this document can be prepared and administered as a combination therapy described in the methods, uses, articles of manufacture or compositions provided, as in pharmaceutical compositions comprising one or more combination therapy agents and a medicament pharmaceutically acceptable carrier, as anyone described herein. In some embodiments, combination therapy in the methods, uses, articles of manufacture or compositions provided can be administered simultaneously, simultaneously or sequentially, in any order with the additional agents, therapy or treatment, where such administration provides therapeutically effective levels each of the agents in the individual's body. In some embodiments, the additional agent may be co-administered with combination therapy in the methods, uses, articles of manufacture or compositions provided, for example, as part of the same pharmaceutical composition or using the same delivery method. In some embodiments, the additional agent is administered simultaneously with cell therapy, for example, dose of modified T cells (for example, RAQ * T cells), but in separate compositions. In some embodiments, the additional agent is incubated with the modified cell, for example, RAQ expression cells, prior to administration of the cells.
[00769] [00769] In some examples, the one or more additional agents are administered subsequently or prior to the administration of cell therapy, for example, dose of modified T cells (for example, RAQ * T cells), separated by a selected period of time. In some instances, the period is 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 1 week, 2 weeks, 3 weeks, | month, 2 months or 3 months. In some instances, one or more additional agents are administered multiple times. In some embodiments, the additional agent is administered prior to cell therapy, for example, dose of modified T cells (T cells RAQ *) in the methods, uses, articles of manufacture or compositions provided, for example, two weeks, 12 days, 10 days, 8 days, a week, 6 days, days, 4 days, 3 days, 2 days or 1 day before administration. In some embodiments, the additional agent is administered after cell therapy, for example, dose of modified T cells (for example, RAQ * T cells) in the methods, uses, articles of manufacture or compositions provided, for example, two weeks, 12 days, 10 days, 8 days, a week, 6 days, 5 days, 4 days, 3 days, 2 days or 1 day after administration.
[00770] [00770] The dose of the additional agent can be any therapeutically effective amount, for example, any amount of dose described herein, and the appropriate dosage of the additional agent can depend on the type of disease being treated, the type, dose and / or frequency of the binding molecule, recombinant receptor, cell and / or composition administered, severity and course of the disease, previous therapy, clinical history of the patient and response to cell therapy, for example, dose of modified T cells (T cells RAQ *) and discretion of the attending physician. SAW. MANUFACTURING ITEMS AND KITS
[00771] [00771] Manufacture articles and kits containing “modified cells expressing a recombinant receptor or its compositions, an optionally d instructions for use, for example, instructions for administration, according to the methods provided, are also provided.
[00772] [00772] In some embodiments, articles of manufacture and / or kits are provided that include a composition comprising a therapeutically effective amount of any of the modified cells described herein, and instructions for administering, to an individual for the treatment of a disease or condition . In some embodiments, the instructions may specify some or all of the elements of the methods provided here. In some embodiments, the instructions specify particular instructions for administering the cells for cell therapy, for example, doses, time, selection and / or identification of individuals for administration and conditions for administration. In some embodiments, the articles of manufacture and / or kits further include one or more additional agents for therapy, for example, lymph node elimination therapy and / or combination therapy, as described in this document, and optionally also includes instructions for administer the additional agent for therapy. In some embodiments, the articles of manufacture and / or kits further comprise an agent for lymph node therapy and, optionally, further include instructions for administering lymphocyte therapy. In some embodiments, instructions can be included as a label or insert that accompanies the compositions for administration.
[00773] [00773] In some modalities, the instructions specify the criteria for selecting or identifying individuals for therapy. In some modalities, these criteria include individuals with NHL or its subtype and / or a high-risk NHL. In some embodiments, the instructions specify that the subjects to be treated include individuals with a disease or condition characterized or determined as aggressive NHL, diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP), large B cells rich in T cell / histocytes (LCBRCTH), Burkitt's lymphoma, lining cell lymphoma (CSF) and / or follicular lymphoma (LF). In particular modalities, the individual to be treated includes individuals with aggressive NHL, in particular, with diffuse large B cell lymphoma (LDGCB), not otherwise specified (NOS) and in some aspects, including again and transformed from indolent) . In some respects, the individual or population to be treated may include and / or include individuals with primary mediastinal B-cell lymphoma (LCBMP) or grade 3B follicular lymphoma (LF3B). In some modalities, the individual or population to be treated includes those individuals with low performance status. In some ways, the population to be treated includes, for example, individuals with an Eastern Cooperative Oncology Group Performance Status (ECOG) that is anywhere from 0-2. In other aspects of any of the modalities, do the individuals to be treated include ECOG 0-1 or do they not include ECOG 2 individuals. In some modalities, of any of the modalities, the individuals to be treated have failed two or more previous therapies. In some modalities, the individual does not have LDOGCB transformed from marginal zone lymphoma (LZM) and chronic lymphocytic leukemia (LLC; Richter) and / or has an LDGCB characterized as de novo or transformed from an indolent disease. In some embodiments, the individual has lining cell lymphoma (CSF) In some embodiments, the instructions specify that the administration of cell therapy is for an individual who is or has been identified as having a double or triple occurrence lymphoma (or high-grade B cells, with MYC and BCL2 rearrangements and / or BCL6 with histology of LDGCB) have been identified as having a chemo-refractory lymphoma (eg, chemo-refractory LDGCB) and / or that has not achieved complete remission (CR) in response to therapy previous.
[00774] [00774] In some embodiments, the instructions specify the dose of cells to be administered. For example, in some embodiments, the dose specified in the instructions includes total recombinant receptor expression cells (for example, RAQ) between about 1 x 10 and 3 x 108, for example, in the range of about 1 x 10 to 2 x 10º these cells, such as 1 x 107, 5 x 107, 1 x 10º or 1.5 x 10º total these cells or the range between two of the previous values. In some modalities, the patient receives multiple doses and each dose or the total dose can be within any of the previous values.
[00775] [00775] In some embodiments, the article of manufacture or kit comprises a container, optionally a vial containing a plurality of CD4 * T cells expressing a recombinant receptor, and a container, optionally a vial containing a plurality of CD8 T cells * that express a recombinant receptor. In some embodiments, the article of manufacture or Kkit comprises a container, optionally a vial that comprises a plurality of CD4 * T cells expressing a recombinant receptor and further comprising, in the same container, a plurality of CD8 * T cells expressing a receptor recombinant. In some embodiments, a cryoprotectant is included in the cells. In some ways, the container is a bag.
[00776] [00776] In some embodiments, the container, such as the vial, comprises greater or greater than about 10 x 10º T cells or recombinant receptor expression T cells, greater than or greater than about 15 x 10º T cells or recombinant receptor expression T cells, greater or greater than about 25 x 106 T cells or recombinant receptor expression T cells. In some respects, the frasconette comprises between about 10 million cells per ml and about 70 million cells per ml, between about 10 million cells per ml and about 50 million cells per ml, between about 10 million of cells per ml and about 25 million cells per ml, between about 10 million cells per ml and about 15 million cells per ml, 15 million cells per ml and about 70 million cells per ml, among about 15 million cells per ml and about 50 million cells per ml, between about 15 million cells per ml and about 25 million cells per ml, between about 25 million cells per ml and about 70 million cells per ml, between about 25 million cells per ml and about 50 million cells per ml and between about 50 million cells per ml and about 70 million cells per ml.
[00777] [00777] In some embodiments, the plurality of vials or plurality of cells or unit dose of cells specified for administration, collectively comprises a dose of cells comprising from or about 1 x 10 to 5 x 108 T cells of receptor expression total recombinant or total T cells, 1 x 105 to 1 x 10 th total recombinant receptor expression T cells or total T cells, from or about 5 x 10 th to 1 x 107 total recombinant receptor expression T cells or T cells total, or from or from about 1 x 10 to 1 x 107 total recombinant receptor expression T cells or total T cells, each inclusive. In some respects, the article comprises one or more unit doses of CD4 * and CD8 * cells or CD4 * receptor * cells and CD8 * receptor * cells, where the unit dose comprises between 1 x 107 and 2 x 10 T cells of recombinant receptor expression, between or about 5 x 107 and at or about 1.5 x 10 10 recombinant receptor expression T cells, approximately 5 x 107 recombinant receptor expression T cells, approximately 1 x 10 10 expression T cells of recombinant receptor, or at or about 1.5 x 10º T cells of recombinant receptor expression, optionally where the information in the article specifies the administration of one or a plurality of unit doses and / or a volume corresponding to that or several unit doses. In some cases, the article comprises one or more unit doses of CD8 * cells, where the dose comprises between or about 5 x 10º and the or about 1 x 10º CD8 * T cells of recombinant receptor expression, the dose comprises between or about 1 x 107 and at or about 0.75 x 10 th CD8 * T cells of recombinant receptor expression, the dose comprises approximately 2.5 x 107 CD8 * T cells of recombinant receptor expression or the dose comprises approximately 5 x 107 CD8 * recombinant receptor expression T cells, or the dose, comprise about 0.75 x 108 CD8 * recombinant receptor expression T cells, optionally where the information in the article specifies the administration of one or one plurality of unit doses and / or a volume corresponding to that or plurality of unit doses. In some embodiments, the cells in the article collectively comprise a dose of cells comprising no more than 1 x 10 th total recombinant receptor expression T cells or total T cells, no more than 1 x 107 recombinant receptor expression T cells total or total T cells, no more than 0.5 x 10 ”total recombinant receptor expression T cells or total T cells, no more than 1 x 10 total recombinant receptor expression T cells or total T cells, no more than 0.5 x 10 th total recombinant receptor expression cells or total T cells.
[00778] [00778] In some embodiments, each vial or plurality of vials or plurality of cells or unit dose of cells specified for administration collectively comprises a flat dose of cells or fixed dose of cells, so that the dose of cells is not linked to or based on an individual's body surface area or weight.
[00779] [00779] In some embodiments, a unit dose of a cell is or comprises the number or quantity of cells, such as modified T cells, that can be administered to an individual or patient in a single dose.
[00780] [00780] In some embodiments, each vial or plurality of vials or plurality of cells or unit dose of cells specified for administration, collectively comprises a dose that includes less than about 5 x 10th total recombinant receptor expression cells ( eg RAQ), T cells or peripheral blood mononuclear cells (PBMCs), for example, in the range of about 1 x 10 to 5 x 108, of such cells, such as 2 x 108, 5 x 108, 1 x 107 , 5x 107, 1 x 108, or 5 x 10º of these total cells, or the range between two of the previous values.
[00781] [00781] In some embodiments, each vial or the plurality of vials or the plurality of cells or unit dose of cells specified for administration collectively comprises a dose of genetically modified cells comprising from or from about 1 x 10 to 5 x 10 cells Total RAQ expression T cells, 1 x 10 th to 2.5 x 10 th total RAQ expression T cells, 1 x 10 th to 1x 10 th total RAQ expression T cells, 1 x 10 th to 5 x 107 T expression cells Total RAQ, 1 x 10 th to 2.5 x 107 total RAQ expression T cells, 1 x 10 th to 1 x 107 total RAQ expression T cells, 1 x 10 th to 5 x 106 total RAQ expression T cells, 1 x 10 th to 2.5 x 10 th total RAQ expression T cells, 1 x 10 th to 1 x 106 total RAQ expression T cells, 1 x 10 th to 5 x 10 th total RAQ expression T cells, 1 x 10 th to 2.5 x 10 th total RAQ expression T cells, 1 x 10 th to 1 x 10 th total RAQ expression T cells, 1 x 10 th to 5 x 107 T total RAQ expression T cells a, 1 x 106 to 2.5 x 107 total RAQ expression T cells, 1 x 10 th to 1 x 107 total RAQ expression T cells, 1 x 10 th to 5 x 10 th total RAQ expression T cells, 1 x 10 th to 2.5 x 10 th total RAQ expression T cells, 2.5 x 10 th to 5 x 10 th total RAQ expression T cells, 2.5 x 10 th to 2.5 x 10 th RAQ expression T cells totals, 2.5 x 106º to 1 x 10º total RAQ expression T cells, 2.5 x 10º to 5 x 107 total RAQ expression T cells, 2.5 x 10º to 2.5 x 107 T cells of RAQ expression total RAQ expression, 2.5 x 10 th to 1 x 107 total RAQ expression T cells, 2.5 x 10 th to 5 x 10 th total RAQ expression T cells, 5 x 106 to 5 x 10 th expression T cells total RAQ, 5 x 10 th to 2.5 x 10 th total RAQ expression T cells, x 10 th to 1 x 10 th total RAQ expression T cells, 5x 10 th to 5x 107 total RAQ expression T cells, 5 x 10th to 2.5 x 107 total RAQ expression T cells, 5 x 10 to 1 x 107 total RAQ expression T cells, 1 x 10º to 5x 10th cell total RAQ expression T cells, 1x107 to 2.5 x 10º total RAQ expression T cells, 1 x 10º to 1x 108 total RAQ expression T cells, 1 x 107 to 5x 107 total RAQ expression T cells , 1 x 107 to 2.5 x 107 total RAQ expression T cells, 2.5 x 107 to 5 x 10th total RAQ expression T cells, 2.5 x 107 to 2.5 x 10th expression T cells total RAQ, 2.5 x 107 to 1 x 10º total RAQ expression T cells, 2.5 x 107 to 5x 107 total RAQ expression T cells, 5 x 107 to 5 x 10º RAQ expression T cells total, 5 x 107 to 2.5 x 10º total RAQ expression T cells, 5 x 107 to 1 x 10º total RAQ expression T cells, 1 x 108º to 5 x 10º total RAQ expression T cells, 1 x 10 th to 2.5 x 10 th total RAQ expression T cells, or 2.5 x 10 th to 5 x 10 th total RAQ expression T cells.
[00782] [00782] In some embodiments, each vial or the plurality of vials or the plurality of cells or unit dose of cells specified for administration collectively comprises a dose of genetically modified cells comprising at least or at least about 1 x 10th expression cells of RAQ, at least or at least about 2.5 x 10 th RAQ expression cells, at least or at least about 5 x 10 th RAQ expression cells, at least or at least about 1 x 10 th expression cells of RAQ, at least or at least about 2.5 x 10th cells of RAQ expression, at least or at least about 5 x 10th cells of RAQ expression, at least or at least about 1 x 107 cells of expression of RAQ, at least or at least about 2.5 x 10 ”cells of RAQ expression, in at least or at least about 5 x 107 cells of RAQ expression, at least or at least about 1 x 10th cells expression of RAQ, at least or at least about 2.5 x 10º RAQ expression cells, or at least or at least about 5 x 10º RAQ expression cells.
[00783] [00783] In some embodiments, the instructions for administering a modified cell dose specify the administration of a number of cells from or about 1 x 10º to 5 x 10 th cells of expression of total recombinant receptors, total T cells or total mononuclear blood of peripheral blood (PBMCs), from or from about 5 x 10 to 1 x 107 total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMC) or from or from about 1 x 10 to 1 x 107 total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMC), each inclusive. In some embodiments, cell therapy comprises administering a dose of cells comprising a number of cells of at least or at least about 1 x 105º total recombinant receptor expression cells, total T cells or peripheral whole blood mononuclear cells (PBMCs) ), such as at least or at least 1 x 10 °, at least or at least about 1 x 10 ”, at least or at least about 1 x 10 ° of these cells. In some embodiments, the number is with reference to the total number of CD3 * or CD8 *, in some cases also recombinant receptor expression cells (for example, RAQ *). In some embodiments, cell therapy comprises administering a dose comprising a number of cells from or from about 1 x 10 th to 5 x 10 th total CD3 * or CD8 * T cells or CD3 * or CD8 recombinant receptor expression cells *, from or from about 10 x 10 to 1 x 10 7 total CD3 * or CD8 * T cells or CD3 * or CD8 * recombinant receptor expression cells or from or from about 1 x 10 to 1 x 107 cells Total CD3 * or CD8 * T cells or CD3 * or CD8 ”recombinant receptor expression cells, each inclusive. In some embodiments, cell therapy comprises administering a dose comprising a number of cells from or from about 1 x 10 th to 5 x 10 th cells CD3 * / RAQ * or total CD8 * / RAQ, from or on an over 5x 10º to 1 x 107 total CD3 * / RAQ * or CD8 * / RAQ cells, or from or about 1x 1086 to 1 x 107 total CD3 * / RAQ * or CD8 * / RAQ cells, each inclusive.
[00784] [00784] In some modalities, the instructions may specify the dosage regimen and the time of administration. For example, in some - embodiments, the instructions may specify the administration to the individual of multiple doses, for example, two or more doses, of the cells. In some embodiments, the instructions specify the timing of multiple doses, for example, the second dose being administered approximately 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 or 21 days after the first dose; and / or the amount of dosage in each dose.
[00785] [00785] In some embodiments, the article of manufacture or Kit comprises a plurality of CD4 * T cells that express a recombinant receptor and instructions for administering to an individual with a disease or condition, all or part of the plurality of CD4 * T cells and additionally administer CD8 * T cells that express a recombinant receptor. In some embodiments, the instructions specify the administration of CD4 * T cells before administering CD8 * cells. In some cases, the instructions specify the administration of CD8 * T cells before administering CD4 * cells. In some embodiments, the article of manufacture or kit comprises a plurality of CD8 * T cells that express a recombinant receptor and instructions for administering to an individual with a disease or condition, all or part of the plurality of CD8 * T cells and T cells CD4 * expression of a recombinant receptor. In some embodiments, the instructions specify the dosage regimen and the timing of cell administration.
[00786] [00786] In some respects, the instructions specify the administration of all or a part of the CD4 * T cells and all or a part of the CD8 * T cells with O at 12 hours of band, O at 6 hours of band or O at 2 hours of track. In some cases, the instructions specify the administration of CD4 * and CD8 * T cells for a maximum of 2 hours, a maximum of 1 hour, a maximum of 30 minutes, a maximum of 15 minutes, a maximum of 10 minutes or a maximum of 5 minutes independently.
[00787] [00787] In some embodiments, the instructions specify the dose or number of cells or cell type (s) and / or a list of cell types, for example, individual populations or subtypes, such as the CD4 * to CD8 * ratio. In some modalities, populations or subtypes of cells, such as CD8 * and CD4 * T cells. For example, in some embodiments, the instructions specify that cells are administered within or within a tolerated range of an output rate of various populations or subtypes of cells, such as CD4 * and CD8 * cells or subtypes, between or approximately 5: 1 ea or about 5: 1 (or greater than about 1: 5 and less than about 5: 1), or between or about 1: 3 and approximately 3:
[00788] [00788] In some embodiments, articles of manufacture and / or kits further include one or more additional agents for therapy, for example, lymphodeplective therapy and / or combination therapy, as described in this document, and optionally instructions for administering the additional agents. In some instances, articles of manufacture may still contain one or more therapeutic agents. In some embodiments, the therapeutic agent is an immunomodulatory agent, a cytotoxic agent, an anti-cancer agent or a radiotherapeutic agent.
[00789] [00789] In some embodiments, articles of manufacture and / or kits also include one or more agents or treatments for treatment, prevention, delay, reduction or mitigation of the development or risk of developing a toxicity and / or instructions for the administration of one or more agents or treatments for treatment, prevention, delay, reduction or mitigation of the development or risk of developing a toxicity in the individual. In some embodiments, the agent is or comprises an anti-IL-6 antibody or anti-IL-6 receptor antibody. For example, in some embodiments, the agent or treatment is or comprises a selected agent - among - tocilizumab, siltuximab, clazakizumab, sarilumab, olokKizumabe (CDP6038), elsiimomabe, ALSSimo / BMS- 945429, sirukumabe (CNTO 136), CPSI-2634 , ARGX-109, FE301 and FM101. For example, in some embodiments, the agent or treatment is or comprises one or more of a steroid; a cytokine or cytokine receptor antagonist or inhibitor selected from IL-10, IL-10R, IL-6, IL-6, IFNy, IF NGR, 1L-2, IL-2R / CD25, MCP-1 receptors, CCR2, CCR4, MIP1IB, CCRS5, TNFalpha, TNFR1, IL-1 and IL-IRalfa / IL-1beta; or an agent capable of preventing, blocking or reducing the activity or function of microglial cells.
[00790] [00790] In some embodiments, the agent capable of preventing, blocking or reducing the activity or function of microglial cells is selected from an anti-inflammatory agent, a NADPH oxidase inhibitor (NOX2), a calcium channel blocker, a sodium channel blocker, which inhibits GM-CSF, inhibits CSFIR, specifically binds to CSF-1, specifically binds to IL-34, inhibits the activation of nuclear factor cover B (NF- «kB), active a CB2 receptor and / or is a CB2 agonist, a phosphodiesterase inhibitor, inhibits microRNA-155 (miR-155) or up-regulates microRNA-124 (miR-124). In some cases, the agent is selected from minocycline, naloxone, nimodipine, Riluzole, MOR103, lenalidomide, a cannabinoid (optional WIN55 or 212-2), intravenous immunoglobulin (IVlg), ibudylast, anti-miR-155 blocked nucleic acid (LNA ), MCS110, PLX-3397, - “PLX647, PLX108-D1, PLX7486, JNJ-40346527, JNJ28312141, ARRY-382, AC-708, DCC-3014, 5- (3-methoxy-4 - (((4-methoxybenzyl ) oxy) benzyl) pyrimidine-2,4-diamine (GW2580), AZD6495, Ki20227, BLZ945, emactuzumab, IMC-CS4, FPAOO8, LY-3022855, AMG-820 and TG-3003. In some embodiments, the agent is an inhibitor of the colony-stimulating factor 1 receptor (CSFIR). For example, agent PLX-3397, PLX647, PLX108-D1, PLX7486, JNJ- 40346527, JNJ28312141, ARRY-382, AC-708, DCC-3014, 5- (3- methoxy-4 - ((4-methoxybenzyl) ) oxy) benzyl |) pyrimidine-2,4-diamine (GW2580), AZD6495, Ki20227, BLZ945 or a pharmaceutical salt or prodrug thereof; emactuzumab, IMC-CS4, FPAO0O8, LY-3022855, AMG-820 and TG-3003 are either antigen-binding fragments or a combination of any of the above.
[00791] [00791] In some embodiments, the articles of manufacture and / or kits also include one or more reagents for the analysis of biological samples, for example, biological samples from individuals candidates for administration or who have been given therapy and, optionally, instructions use of reagents or assays. In some embodiments, the biological sample is or is obtained from a blood, plasma or serum sample. In some embodiments, the reagents may be used before administration of cell therapy or after administration of cell therapy, for diagnostic purposes, to identify individuals and / or to assess treatment results and / or toxicities. For example, in some modalities, the article of manufacture and / or kits also contains reagents to measure the level of specific biomarkers, for example, cytokines or analyzed, which are associated with toxicity and measurement instructions. In some embodiments, the reagents include components for performing an in vitro assay to measure biomarkers (for example, analyzed), such as an immunoassay, an aptamer-based assay, a histological or cytological assay or an expression level test. mMRNA. In some embodiments, the in vitro assay is selected from an enzyme-linked immunosorbent assay (ELISA), immunoblotting, immunoprecipitation, = radioimmunoassay (RIA), immunoblotting, flow cytometry assay, surface plasmon resonance
[00792] [00792] In some embodiments, articles of manufacture and / or kits comprise one or more reagents capable of detecting one or more analyzed and instructions for using the reagent to test a biological sample of an individual who is a candidate for treatment, in which the one or more analyzed is selected from LDH, ferritin, CRP, IL-6, I1L-7, IL-8, I1L-10, I1L-15, I1L-16, TNF-alpha, IFN-gamma, MCP-1, MIP -1beta, eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, IP-10, perforin and D-dimer (fibrin degradation product) ຠIn some modalities, instructions are also included to test the presence or absence, level, quantity or concentration of one analyzed in the individual, compared to a threshold level of the analyzed.
[00793] [00793] In some modalities, instructions are included that specify whether the level, quantity or concentration of the analyzed in the sample is equal to or higher than a threshold level for the analyzed, administering to the individual an agent or other treatment capable of treating, preventing , delay, reduce or mitigate the development or risk of developing a toxicity (i) prior to, (ii) within one, two or three days after, (ili) concomitantly with and / or (iv) in the first fever to follow , the beginning of the administration of cell therapy to the individual. In some cases, the instructions specify that if the level, quantity or concentration of the analyte in the sample is equal to or above a threshold level for the analyzed, the cell therapy is administered to the individual in a reduced dose or in a dose that is not associated with risk of developing toxicity or severe toxicity, or not associated with a risk of developing toxicity or severe toxicity in most individuals and / or most individuals with a disease or condition that the individual has or is suspected to have, after administration of cell therapy. In some cases, the instructions specify that, if the level, quantity or concentration of the analyzed in the sample is equal to or above a threshold level for the analyzed, the cell therapy is administered in a hospital environment and / or with admission to the hospital by one or more more days, optionally when cell therapy should be administered otherwise to individuals on an outpatient basis or without admission to the hospital for one or more days.
[00794] [00794] In some embodiments, the instructions for administering cell therapy specify whether the level, quantity or concentration of the analyte in the sample is below a threshold level, administering to the individual cell therapy, optionally in a non-reduced dose, optionally in on an outpatient basis or without admission to the hospital for one or more days. In some embodiments, the instructions for administering cell therapy specify whether the level, amount or concentration of the analyte in the sample is below a threshold level, before or simultaneously with the administration of cell therapy and / or before the development of a sign or symptom of a toxicity other than fever, an agent or treatment capable of treating, preventing, delaying or mitigating the development of toxicity is not administered to the individual. In some respects, the instructions for administering cell therapy specify that if the level, quantity or concentration of the analyte in the sample is below a threshold level, the administration of cell therapy must be or can be administered to the individual in an outpatient setting and / or without admission of the individual to the hospital overnight or for one or more consecutive days and / or is without admission of the individual to the hospital for one or more days.
[00795] [00795] Articles of manufacture and / or kits may also include cell therapy and / or include instructions for use with, before and / or in connection with treatment with cell therapy. In some embodiments, instructions are included to administer the agent and the instructions specify whether the level, quantity or concentration of the analyte in the sample is at or above a threshold level that the agent administers to the individual. In some aspects, the instructions further specify the administration of a cell therapy to the individual, in which the administration of the agent must be performed (i) before, (ii) within one, two or three days after, (iii) simultaneously with and / or (iv) in the first fever after the start of the administration of cell therapy to the individual.
[00796] [00796] Articles of manufacture and / or kits may include a container and a label or insert or associated with the container. Suitable containers include, for example, bottles, vials, syringes, solution bags | V, etc. Containers can be formed from a variety of materials, such as glass or plastic. The container in some embodiments contains a composition that is either alone or combined with another composition effective to treat, prevent and / or diagnose the condition. In some embodiments, the container has a sterile access door. Exemplary containers include bags of intravenous solution, vials, including those with needle-piercing stoppers for injection, or vials or vials for agents administered orally. The label or insert may indicate that the composition is used to treat a disease or condition. The article of manufacture may include (a) a first container with a composition contained therein, wherein the composition includes modified cells that express a recombinant receptor; and (b) a second container with a composition contained therein, wherein the composition includes the second agent. In some embodiments, the article of manufacture may include (a) a first container with a first composition contained therein, wherein the composition includes a subtype of modified cells that express a recombinant receptor; and (b) a second container with a composition contained therein, wherein the composition includes a different subtype of modified cells that express a recombinant receptor. The article of manufacture may also include an insert indicating that the compositions can be used to treat a specific condition. Alternatively, or in addition, the article of manufacture may further include another or the same container comprising a pharmaceutically acceptable buffer. It may also include other materials, such as other buffers, thinners, filters, needles and / or syringes. VII. EXEMPLARY MODALITIES
[00797] [00797] Among the modalities provided, are:
[00798] [00798] 1.The method for treating an individual who has or suspects a disease or condition, the method comprising administering to the individual a dose of CD4 * and CD8 * T cells, each of the CD4 * and CD8 * T cells individually comprising a receptor that specifically binds to a target antigen expressed by the disease or condition or to a cell or tissue thereof and / or that is associated with the disease or condition, wherein the administration comprises administering a plurality of separate compositions, the plurality of separate compositions comprising a first composition comprising one of the CD4 * T cells and CD8 * T cells and administration of a second composition comprising the other of the CD4 * T cells and CD8 * T cells.
[00799] [00799] 2 The method of mode 1, wherein the receptor comprised of CD4 * T cells and / or the receptor comprised of CD8 * T cells comprises a recombinant receptor and / or in which CD4 * T cells and / or cells CD8 * T are genetically modified to express the receptor.
[00800] [00800] 3. The method of mode 1 or mode 2, wherein: the administration of the first composition and the administration of the second composition are carried out on the same day, they are carried out between about 0 and about 12 hours interval, between about 0 to about 6 hours apart or between about 0 and 2 hours apart; or initiation of administration of the first composition and initiation of administration of the second composition are carried out between about 1 minute and about 1 hour apart or between about 5 minutes and about 30 minutes apart.
[00801] [00801] 4 The method of any of the modalities 1 - 3, in which the first composition and the second composition are administered no more than 2 hours, no more than 1 hour, no more than 30 minutes, no more than than 15 minutes, no more than 10 minutes or no more than 5 minutes apart.
[00802] [00802] 5. The method of any of the modalities 1 - 4, wherein the first composition comprises CD4 * T cells.
[00803] [00803] 6. The method of any of the modalities 1 - 5, wherein the first composition comprises CD8 * T cells.
[00804] [00804] 7.The method of any of the modalities 1 - 6, in which the administration of the first composition is initiated before the administration of the second composition is started.
[00805] [00805] 8 The method of any of the modalities 1 - 7, wherein: the cell dose comprises a defined ratio of CD4 * cells that express a recombinant receptor to CD8 * cells that express a recombinant receptor and / or CD4 cells *
[00806] [00806] 9. The method of mode 8, in which the defined ratio is or is approximately 1: 1.
[00807] [00807] 10.The method of any of the modalities 1 - 9, wherein the dose of T cells is administered to the individual as a single dose or is administered only once within a period of two weeks, one month, three months , six months, | year or more.
[00808] [00808] 11.The method of any of the modalities 1 - 9, in which the dose of T cells is administered as a double dose, comprising a first dose of T cells and a consecutive dose of T cells, in which one or both of the first dose and the second dose comprises administering the plurality of T cell composition.
[00809] [00809] 12. The method of modality 11, wherein the consecutive dose is administered at a point in time that is at least or more than about 7 days or 14 days after and less than about 28 days after the start of administration the first dose of cells.
[00810] [00810] 13.The method of any of the modalities 1 - 12, wherein: the cell dose comprises between or about 1 x 10º and approximately 5 x 10º T cells of total recombinant receptor expression or total T cells between or about 1 x 10º and to or about 1 x 10º total recombinant receptor expression T cells or total T cells, between or about 5 x 10º and to or about 1 x 107 total recombinant receptor expression T cells or total T cells, or between or about 1 x 10 ° and to or about 1 x 107 total recombinant receptor expression T cells or total T cells, each inclusive.
[00811] [00811] 14. The method of any of the modalities 1 - 13, wherein the dose of T cells comprises the administration of no more than 1 x 10 th total recombinant receptor expression T cells or total T cells, no more than than 1 x 107 total recombinant receptor expression T cells or total T cells, not more than 0.5 x 107 total recombinant receptor expression T cells or total T cells, not more than 1 x 10 th expression T cells total recombinant receptor or total T cells, no more than 0.5 x 10 th total recombinant receptor expression T cells or total T cells.
[00812] [00812] 15.The method of any of the modalities 1 - 14, wherein the dose of CD4 * and CD8 * T cells comprises: between about 5 x 107 T cells of recombinant receptor expression and about 1 x 10 th cells Recombinant receptor expression T, each inclusive; between or about 1 x 10 7 and at or about 2 x 10 10 recombinant receptor expression T cells; between or about 5 x 10 7 and at or about 1.5 x 10 10 recombinant receptor expression T cells at or about 5 x 10 7 recombinant receptor expression T cells; or at or about 1 x 10th T cells of recombinant receptor expression; or the dose comprises approximately 1.5 x 10 10 T cells of recombinant receptor expression; between or about 5 x 10 6 and at or about 1 x 10 8 CD8 * T cells of recombinant receptor expression; between or about 1 x 107 and at or about 0.75 x 10 th CD8 * T cells of recombinant receptor expression; to about 2.5 x 10 7 CD8 * T cells that express recombinant receptor; in about 5 x 10 7 CD8 * T cells that express recombinant receptor; and / or at or about 0.75 x 10 th CD8 * T cells of recombinant receptor expression.
[00813] [00813] 16.The method of any of the modalities 1 - 15, wherein the recombinant receptor specifically binds to an antigen associated with the disease or condition or expressed in cells of the environment of an injury associated with the disease or condition.
[00814] [00814] 17.The method of any of the modalities 1 - 16, in which the disease or condition is a cancer.
[00815] [00815] 18.The method of any of the modalities 1 - 17, in which the disease or condition is a myeloma, leukemia or lymphoma.
[00816] [00816] 19.The method of any of the modalities 1 - 18, in which the antigen is ROR1, B cell maturation antigen (AMCB), carbonic anhydrase 9 (CAIX), tEGFR, Her2 / neu (receptor tyrosine kinase erbB2 ), LI-CAM, CD19, CD20, CD22, mesothelin, CEA and hepatitis B surface antigen, antifolate receptor, CD23, CD24, CD30, CD33, CD38, CD44, EGFR, epithelial glycoprotein 2 (GEP-2),
[00817] [00817] 20.The method of any of the modalities 1 - 19, in which the antigen is CD19.
[00818] [00818] 21.The method of any of the modalities 1 - 20, in which the disease or condition is a B-cell malignancy and / or is adult acute lymphoblastic leukemia (ALL), chronic lymphoblastic leukemia (LLC), lymphoma non-Hodgkin (NHL) and Diffuse Large B Cell Lymphoma (LDGCB).
[00819] [00819] 22.The method of any of the modalities 1 - 21, in which the disease or condition is NHL and NHL is selected from the group consisting of aggressive NHL, diffuse large B cell lymphoma
[00820] [00820] 23.The method of any of modalities 1 - 22, wherein the recombinant receptor is a chimeric antigen (RAQ) receptor, optionally wherein the recombinant receptor is a chimeric antigen (RAQ) receptor, optionally wherein the RAQ comprises an extracellular antigen recognition domain that specifically binds to the antigen and an intracellular signaling domain comprising an ITAM, wherein optionally, the intracellular signaling domain comprises an intracellular domain of a CD3-zeta (CD37) chain; and / or wherein the RAQ further comprises a co-stimulating signaling region, which optionally comprises a CD28 or 4-1BB signaling domain.
[00821] [00821] 24. Article of manufacture, comprising (1) a vial containing a composition comprising a plurality of CD4 * T cells expressing a recombinant receptor and (2) instructions for administration, to an individual with a disease or condition: a unit dose of cells of the composition, the unit dose comprising all or a portion of the plurality of CD4 * T cells and a unit dose of a composition comprising CD8 * T cells expressing a recombinant receptor, wherein the vial does not comprise the dose unitary composition comprising CD8 * T cells expressing the recombinant receptor.
[00822] [00822] 25. An article and of manufacture, comprising (1) a vial containing a composition comprising a plurality of CD8 * T cells expressing a recombinant receptor and (2) instructions for administration to an individual with a disease or condition : a unit dose of cells in the composition, the unit dose comprising all or a portion of the plurality of CD8 * T cells and a unit dose of a composition comprising CD4 * T cells expressing a recombinant receptor, in which the vial does not comprise the unit dose of the composition comprising CD4 * T cells that express the recombinant receptor.
[00823] [00823] 26.0 article of manufacture of modality 24 or modality 25, in which: the recombinant receptor expressed by CD4 * cells and the recombinant receptor expressed by CD8 * T cells is the same; the recombinant receptor expressed by CD4 * cells and the recombinant receptor expressed by CD8 * T cells is different; or the recombinant receptor expressed by CD4 * cells and the recombinant receptor expressed by CD8 * T cells bind to the same antigen, which is expressed by or associated with the disease or condition or cell or tissue thereof.
[00824] [00824] 27. Article of manufacture, according to any of the modalities 24 to 26, in which the vial comprises greater or greater than about 10 x 10 T cells or T cells of recombinant receptor expression, greater or greater than than about 15 x 10 th recombinant receptor expression T cells or T cells, greater or greater than about 25 x 10 th recombinant receptor expression T cells or T cells.
[00825] [00825] 28. The article of manufacture of any of the modalities 24-27, in which the vial comprises between about millions of cells per ml and about 70 million cells per ml, between about 10 million cells per ml and about 50 million cells per ml, between about 10 million cells per ml and about 25 million cells per ml, between about 10 million cells per ml and about 15 million cells per ml, 15 million of cells per ml and about 70 million cells per ml, between about 15 million cells per ml and about 50 million cells per ml, between about 15 million cells per ml and about 25 million cells per ml, between about 25 million cells per ml and about 70 million cells per ml, between about 25 million cells per ml and about 50 million cells per ml and between about 50 million cells per ml and about 70 million cells per ml.
[00826] [00826] 29 The article of manufacture of any of the modalities 24-28, in which the composition further comprises a cryoprotectant and / or the article further includes instructions for defrosting the composition before administration to the individual.
[00827] [00827] 30. The article of manufacture of any of the modalities 24-29, in which: the plurality of CD4 * cells that express the recombinant receptor and the plurality of CD8 * cells that express the recombinant receptor in the article and / or the CD4 * cells and CD8 * cells in the vial are present in a defined ratio, which optionally is either approximately 1: 1 or between approximately 1: 3 and approximately 3: 1; and / or the article further comprises information or instructions that specify the administration of the plurality of cells to a defined ratio of cells of the plurality of CD4 * cells that express the recombinant receptor and cells of the plurality of CD8 * cells that express the recombinant receptor and / or CD4 * cells and CD8 * cells, the ratio of which is optionally, is approximately 1: 1 or approximately 1: 3 and approximately 3: 1; and / or the article further comprises information or instructions that specify the administration of formulations in the bottles in a defined volumetric or weight-based relationship, which optionally is equal to or about | : 1 and / or between or about 3: 1 and approximately 1: 3, in volume or weight, and / or optionally corresponds to a ratio of CD4 * cells that express the recombinant receptor to CD8 * cells that express the recombinant receptor and / or CD4 * cells to CD8 * cells, the ratio of which is optionally at or is approximately 1: 1 or between approximately 1: 3 and approximately 3: 1.
[00828] [00828] 31.The article of manufacture of modality 30, in which the defined ratio is or is approximately 1: 1.
[00829] [00829] 32. The article of manufacture of any of the modalities 24-31, wherein the plurality of vials or plurality of cells or unit dose of cells specified for administration, collectively comprises a dose of cells comprising of or about 1x 10 th to 5 x 10 th total recombinant receptor expression T cells or total T cells, 1 x 10 th to 1 x 10 th total recombinant receptor expression T cells or total T cells, from or from about 5 x 10 th to 1 x 107 total recombinant receptor expression T cells or total T cells, or from or from about 1 x 10 th to 1 x 107 total T cells expressing recombinant receptor or total T cells, each inclusive; the article comprises one or more unit doses of CD4 * and CD8 * cells or CD4 * receptor * cells and CD8 * receptor cells ”, where the unit dose comprises between or about 1 x 10º” and a or about 2 x 10th recombinant receptor expression T cells, between or about 5 x 10 7 and at or about 1.5 x 10 10 recombinant receptor expression T cells, at or about 5 x 10 7 recombinant receptor expression T cells, a or about 1 x 10 th cells
[00830] [00830] 33. The article of manufacture of any of the modalities 24-32, wherein the cells in the article collectively comprise a dose of cells comprising no more than 1 x 10 th total recombinant receptor expression T cells or cells Total T, no more than 1 x 107 total recombinant receptor expression T cells or total T cells, no more than 0.5 x 107 total recombinant receptor expression T cells or total T cells, no more than 1 x 10th total recombinant receptor expression T cells or total T cells, not more than 0.5 x 10th total recombinant receptor expression T cells or total T cells.
[00831] [00831] 34. The article of manufacture of any of the modalities 24-33, wherein the plurality of recipients, collectively, comprises a dose of cells comprising: between about 5 x 107 T cells of recombinant receptor and 1 x 10th recombinant receptor expression T cells, each inclusive; between or about 1 x 10 ° and to or about 2 x 10 ° recombinant receptor expression T cells; between or about 5 x 10 7 and at or about 1.5 x 10 10 recombinant receptor expression T cells; a or about 5 x 10 7 recombinant receptor expression T cells; a or about 1 x 10 10 recombinant receptor expression T cells; at about 1.5 x 10 6 recombinant receptor expression T cells; between or about 5 x 10 ° and at or about 1 x 10 ° CD8 * T cells of recombinant receptor expression; between or about 1 x 10 ° and at or about 0.75 x 10 ° CD8 * T cells of recombinant receptor expression; to about 2.5 x 10 7 CD8 * T cells that express recombinant receptor; in about 5 x 10 ”CD8 * T cells that express recombinant receptor; or at or about 0.75 x 10 th CD8 * T cells of recombinant receptor expression.
[00832] [00832] 35. The article of manufacture of any of the modalities 24-34, in which the instructions specify the administration of all or a portion of the CD4 * T cells and the totality or a portion of the CD8 * T cells with O to 12 hours apart, 0 to 6 hours apart or 0 to 2 hours apart.
[00833] [00833] 36. The article of manufacture of any of the modalities 24-34, in which the instructions specify the administration of CD4 * and CD8 * T cells for no more than 2 hours, no more than 1 hour, no more than than 30 minutes, no more than 15 minutes, no more than 10 minutes or no more than 5 minutes.
[00834] [00834] 37. The article of manufacture of any of the modalities 24-36, in which the instructions specify the administration of CD4 * T cells before the administration of CD8 * cells.
[00835] [00835] 38. The article of manufacture of any of the modalities 24-36, in which the instructions specify the administration of CD8 * T cells before the administration of CD4 * cells.
[00836] [00836] 39 The article of manufacture of any of the modalities 24-38, in which the recombinant receptor binds specifically to an antigen associated with the disease or condition or expressed in the cells of the environment of an injury associated with the disease or condition.
[00837] [00837] 40. The article of manufacture of any of the modalities 24-39, in which the disease or condition is a cancer.
[00838] [00838] 41. The article of manufacture of any of the modalities 24-40, in which the disease or condition is a myeloma, leukemia or lymphoma.
[00839] [00839] 42. The article of manufacture of any of the modalities 24-41, in which the antigen is ROR1, B cell maturation antigen (AMCB), carbonic anhydrase 9 (CAIX), tEGFR, Her2 / neu (tyrosine receptor erbB2 kinase), LI-CAM, CD19, CD20, CD22, mesothelin, CEA and hepatitis B surface antigen, antifolate receptor, CD23, CD24, CD30, CD33, CD38, CD44, EGFR, epithelial glycoprotein 2 (GEP-2) , epithelial glycoprotein 40 (EPG-40), EPHa2, erb-B2, erb-B3, erb-B4, erbB, EGFR vill, folate-binding protein (FBP), FCRL5, FOCRHS5, fetal acetylcholine receptor,
[00840] [00840] 43. The article of manufacture of any of the modalities 24-42, in which the antigen is CD19.
[00841] [00841] 44 The article of manufacture of any of the modalities 24-43, in which the disease or condition is a malignancy of B cells and / or is acute lymphoblastic leukemia (ALL), adult ALL, chronic lymphoblastic leukemia (LLC) , non-Hodgkin's lymphoma (NHL) and diffuse large B-cell lymphoma (LDGCB).
[00842] [00842] 45. The article of manufacture of any of the modalities 24-44, in which the disease or condition is NHL and the NHL is selected from the group consisting of aggressive NHL, diffuse large B cell lymphoma (LDGCB), NOS (again and turned into indolent), primary mediastinal large B-cell lymphoma (LCBMP), large cell / histocyte-rich B-cell lymphoma
[00843] [00843] 46. The article of manufacture of any of the modalities 24-45, in which T cells are primary T cells obtained from an individual.
[00844] [00844] 47. The article of manufacture of any of the modalities 24-46, in which the T cells are autologous to the individual.
[00845] [00845] 48. The article of manufacture of any of the modalities 24-46, in which the T cells are allogeneic to the individual.
[00846] [00846] 49. Method for treating an individual with or with suspected B-cell malignancy, optionally non-Hodgkin's lymphoma (NHL), the method comprising administering to the individual a dose of T cells comprising T cells that express a receptor of chimeric antigen (RAQ) that specifically binds to a target antigen expressed by NHL, where: the dose of T cells comprises between about 2.5 x 107 T cells of RAQ expression and 2 x 10 T cells of expression of RAQ, inclusive, optionally between or about 5 x 107 T cells of RAQ expression and to or about 1 x 10º T cells of RAOQ expression, inclusive; and malignancy, optionally NHL, comprises diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP), NOS (again or transformed from indolent lymphoma) or Grade 3B follicular lymphoma and in which the individual is or has been identified as having an Eastern Cooperative Oncology Group Performance Status (ECOG) status of O or 1, optionally in which the method further comprises identifying the individual as having diffuse large B cell lymphoma (LDGCB), large lymphoma primary mediastinal B cells (LCBMP), NOS (again or transformed from indolent lymphoma) or Grade 3B follicular lymphoma with an ECOG status of O or 1.
[00847] [00847] 50.The method of mode 49, wherein the dose of T cells comprises a defined ratio of CD4 * cells expressing RAQ and CD8 * cells expressing RAQ and / or CD4 * cells to CD8 * cells, whose ratio is optionally approximately 1: 1 or between or about 1: 3 and approximately 3: 1.
[00848] [00848] 51. A method of treating an individual with non-Hodgkin's lymphoma (NHL), the method comprising administering to the individual a dose of T cells comprising T cells that express a chimeric antigen receptor (RAQ) that binds specifically to a target antigen expressed by NHL, the dose of T cells comprising a defined ratio of CD4 * cells that express RAQ and CD8 * cells that express RAQ and / or CD4 * cells to CD8 * cells, the ratio of which is approximately or is 1: 1, where NHL comprises diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP), NOS (new or transformed from indolent lymphoma) or Grade 3B follicular lymphoma.
[00849] [00849] 52.The method of modality 51, in which the individual is or has been identified as having an Eastern Cooperative Oncology Group Performance Status (ECOG) of 0, 1 or 2.
[00850] [00850] 53.The method of modality 51 or modality 52, in which the individual is or has been identified as having an ECOG status of 0 or
[00851] [00851] 54.The method of any of the modalities 49-53, in which: at least 35%, at least 40% or at least 50% of the individuals treated according to the method achieve a complete response (RC), optionally where CR is durable or is durable in at least 60%, 70%, 80%, 90% or 95% of individuals who reach CR for a period of 3 months or more or more than 6 months; and / or at least 60%, 70%, 80%, 90% or 95% of individuals who achieve CR in one month and / or in three months remain in response, remain in CR and / or survive or survive without progression, for more than 3 months or more and / or more than 6 months and / or more than 9 months; and / or at least 50%, at least 60% or at least 70% of the individuals treated according to the method achieve an objective response (RO) optionally, in which the RO is durable or is at least 60%, 70% durable , 80%, 90% or 95% of individuals who reached the RO for a period of 3 months or more or more than 6 months; and / or at least 60%, 70%, 80%, 90% or 95% of the individuals who reach the RO remain in response or survive for more than 3 months and / or for more than 6 months; and / or at least 40%, at least 50%, at least 60%, at least 70% of the individuals who, at or before the dose of the cells, had or were identified as having a double or triple occurrence lymphoma or relapse, optionally relapse within 12 months, after administration of an autologous stem cell transplant (TACT), achieved an OR, optionally in which the OR is durable for at least 3 months or at least 6 months.
[00852] [00852] 55.The method of any of the modalities 49-54, in which: the cells are autologous to the individual and a minimum absolute lymphocyte count (CLA) is not necessary for apheresis and / or specified for the production of the therapy; and / or cells are produced by a process that, for at least 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% of individuals with the disease or condition or the selected population of individuals, is capable of generating a cellular product for administration and results according to the method.
[00853] [00853] 56.The method of any of the modalities 49-55, in which: greater or greater than about 50%, about 60%, about 70% or about 80% of the individuals treated according to the method do not exhibit a cytokine release syndrome (SLC) grade 3 or higher and / or do not exhibit neurotoxicity grade 3 or higher and / or greater than 40% or 50% or 55% do not exhibit neurotoxicity or SLC.
[00854] [00854] 57. Method of treating an individual with non-Hodgkin's lymphoma (NHL), the method comprising administering to the individual a dose of T cells comprising T cells expressing a specifically binding chimeric antigen (RAQ) receptor to a target antigen expressed by the NHL, where: the dose of T cells comprises between about 5 x 107 T cells of recombinant receptor expression and 1 x 10 T cells of recombinant receptor expression, including, said dose comprising a relationship defined number of CD4 * cells that express the recombinant receptor for CD8 * cells that express the recombinant receptor and / or CD4 * cells for CD8 * cells, the ratio of which is approximately or is 1: 1; and the method results in (1) a complete response (CR) in at least 35%, at least 40% or at least 50% of the treated individuals and / or objective response (RO) in at least 50%, at least 60% or at least 70% of treated individuals and (2)
[00855] [00855] 58.The method of modality 57, in which at least 40%, at least 50%, at least 60%, at least 70% of the individuals who, at or before the administration of the cell dose, had or were identified as having a double or triple lymphoma occurring or relapsing after administration of an autologous stem cell transplant (TACT), he achieved an OR, optionally, in which the OR is durable for at least 3 months or 6 months or more.
[00856] [00856] 59.The method of modality 57, in which: CR or RO is durable for more than 3 months or more than 6 months; and / or at least 20%, at least 25%, at least 35%, at least 40% or at least 50% of the individuals treated according to the method achieve a durable CR; and / or at least 60%, 70%, 80%, 90% or 95% of individuals treated with the method and who reach CR, remain in CR or remain in response or remain in response or survive for at least 3 months or at least 6 months or 9 months or more; and / or at least 60%, 70%, 80%, 90% or 95% of individuals treated with the method who achieve CR for one month and / or for three months remain in response, remain in CR and / or survive or survive without progression, for more than 3 months and / or for more than 6 months and / or for more than 9 months; and / or at least 50%, at least 60% or at least 70% of the individuals treated according to the method achieve an objective response (RO) optionally, in which the RO is durable or is at least 60%, 70% durable , 80%, 90% or 95% of individuals who reached the RO for a period of 3 months or more or more than 6 months; and / or at least 60%, 70%, 80%, 90% or 95% of individuals treated with the method and reaching an RO remain in response or survive for more than 3 months and / or for more than 6 months.
[00857] [00857] 60.The method of any of the modalities 49-59, in which: on or before the administration of the cell dose, the individual is or was identified as having an associated lymphoma or involving the central nervous system (CNS) involvement ; and / or at least 70%, at least 80%, at least 90% or at least 95% of the subjects treated according to the method that, on or before administration of the displayed cell dose or has been identified as exhibiting a lymphoma with CNS involvement, achieved a resolution of CNS disease.
[00858] [00858] 61.A method of treating an individual, the method comprising administering to an individual who has lymphoma, a dose of T cells comprising T cells that express a chimeric antigen receptor (RAQ) that specifically binds to a target antigen expressed by lymphoma, in which the individual's lymphoma is associated with or involves central nervous system (CNS) involvement.
[00859] [00859] 62.The method of modality 60 or modality 61, in which, at the time or before the administration of the cell dose, the individual comprises a brain injury, optionally a brain injury in the temporal lobe.
[00860] [00860] 63.The method of modality 62, in which the lymphoma is a malignancy of B cells.
[00861] [00861] 64.The method of mode 61 or mode 62, wherein the lymphoma is a non-Hodgkin's lymphoma (NHL).
[00862] [00862] 65.The method of any of the 60-64 modalities, in which: at least 35%, at least 40% or at least 50% of the individuals treated according to the method achieve a complete response (CR) or remission CNS disease, optionally in which CR or remission of CNS disease is durable or is durable in at least 60%, 70%, 80%, 90% or 95% of individuals who have reached CR for at least 3 months or at most or 6 months; and / or at least 60%, 70%, 80%, 90% or 95% of individuals who achieve CR or remission of CNS disease in one month and / or in three months remain in response, remain in CR and / or survive or survive without progression, for more than 3 months and / or for more than 6 months and / or for more than 9 months; and / or at least 50%, at least 60% or at least 70% of the individuals treated according to the method achieve an objective response (OR) or remission of the CNS disease optionally, in which the OR or remission of the CNS disease is durable or is durable in at least 60%, 70%, 80%, 90% or 95% of individuals who obtain CR, for a period of 3 months or more or more than 6 months; and / or at least 60%, 70%, 80%, 90% or 95% of individuals who achieve OR or remission from CNS disease remain in response or survive for more than 3 months and / or for 6 months; and / or the brain injury is reduced in size or volume, optionally greater or greater than about 25%, 50%, 75% or more; and / or reduction or remission or clearance of CNS disease is achieved, optionally in at least 35%, at least 40% or at least 50% of the subjects treated according to the method.
[00863] [00863] 66.The method of any of the modalities 49-65, in which: greater or greater than about 30%, 35%, 40% or 50% of the individuals treated according to the method do not exhibit any degree of cytokine release syndrome (SLC) or neurotoxicity; and / or at least 45%, 50%, 60%, 65%, 70%, 75%, 80%, 85%, 90% or 95% of the individuals treated according to the method do not have SLC or early-onset neurotoxicity and / or do not show onset of SLC before 3 days after the start of administration and / or do not show onset of neurotoxicity before 5 days after start of administration and / or where the median onset of neurotoxicity among subjects treated according to the method is at or after the mean peak or mean resolution time of the SLC in individuals treated according to the method and / or the median onset of neurotoxicity among individuals treated according to the method is greater than or equal to 8.9, 10 or 11 days.
[00864] [00864] 67.The method of any of the modalities 49-66, in which: prior to the start of the cell dose administration, the individual did not receive an agent or treatment capable of treating, preventing, delaying, reducing or attenuating the development or risk of developing toxicity; and / or the individual is not administered an agent or treatment for the treatment or prevention or reduction or mitigation of neurotoxicity and / or cytokine release syndrome or risk thereof, within a period after the dose is administered, during which period it is optionally either about 1, 2, 3, 4, 5 days, or it is optionally at 6, 7, 8, 9, 10, 11 days, at or about 1, 2, 3 or 4 weeks; and / or the individual is not administered an agent or treatment for the treatment or prevention or reduction or mitigation of neurotoxicity and / or cytokine release syndrome or risk thereof, after dose administration, before or unless the individual shows a sign or symptom of toxicity and / or before or unless the individual exhibits a sign or symptom of toxicity other than fever, optionally where the fever is not a prolonged fever or the fever is or has been reduced or reduced further 1 ºC after treatment with an antipyretic; and / or administration and any follow-up are performed on an outpatient basis and / or without the patient's admission to a hospital and / or without an overnight stay in a hospital and / or without the need for admission or overnight stay in a hospital, optionally, unless or even the individual has prolonged fever or fever that has been reduced or not reduced by more than 1ºC after treatment with antipyretic.
[00865] [00865] 68.The method of any of the modalities 49-67, wherein: prior to the start of the cell dose administration, the individual did not receive an anti-ll-6 or anti-IL-6R antibody, optionally tocilizumab or siltuximab, and / or did not receive a steroid, optionally dexamethasone; and / or the individual does not receive an anti-IL-6 or anti-IL-6R antibody, optionally tocilizumab or siltuximab, and / or does not receive a steroid, optionally dexamethasone, within a period after dose administration, during which time time is optional in approximately 1, 2, 3, 4, 5 days, or in 6, 7, 8, 9, 10, 11 days or in approximately 1, 2, 3 or 4 weeks; and / or the individual does not receive an anti-IL-6 or anti-IL-6R antibody, optionally tocilizumab or siltuximab, and / or has not received a steroid, optionally dexamethasone, after administration of the cell dose, before or unless, the individual exhibits a sign or symptom of a toxicity, optionally a neurotoxicity or SLC and / or before, or unless, unless the individual exhibits a sign or symptom of a toxicity, optionally a neurotoxicity or SLC, other than fever, optionally where the fever is not a prolonged fever or the fever is or has been reduced or reduced by more than 1 ° C after treatment with antipyretic; and / or administration and any follow-up are carried out on an outpatient basis and / or without the patient's admission to a hospital and / or without an overnight stay in a hospital and / or without the need for admission or overnight stay in a hospital, optionally unless or until the individual has a prolonged fever or that has been reduced or not reduced by more than 1 ºC after treatment with antipyretic.
[00866] [00866] 69.The method of any of the modalities 49-67, in which: administration is performed on an outpatient basis and / or without the need for admission or overnight in a hospital; and if the individual has a prolonged fever or fever that has been reduced or not reduced by more than 1 ºC after treatment with antipyretic, the patient is admitted to the hospital or overnight in the hospital and / or administered an agent or treatment for the treatment or preventing or reducing or mitigating a neurotoxicity and / or cytokine release syndrome or risk of it.
[00867] [00867] 70.The method of any of the modalities 49-60 and 64-69, in which the LNH is selected from the group consisting of aggressive LNH, diffuse large B cell lymphoma (LDGCB), NOS (again and transformed from indolent), primary large mediastinal B cell lymphoma (LCBMP), lining cell lymphoma (CSF) and / or follicular lymphoma (LF), optionally Grade 3B follicular lymphoma (LF3B).
[00868] [00868] 71.The method of any of the modalities 49-60 and 64-70, in which the LNH comprises diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP), NOS (again or transformed from indolent lymphoma), or Grade 3B follicular lymphoma.
[00869] [00869] 72.The method of any of the modalities 49-60 and 64-71, in which the NHL comprises LDGCB.
[00870] [00870] 73.The method of any of the modalities 49-60 and 70-72, in which the LDGCB does not comprise LDGCB transformed from MZL and CLL (Richter) and / or the individual administered the cell dose has an LDGCB characterized as de novo or transformed from indolent and / or does not comprise an LDGCB transformed from MZL and CLL.
[00871] [00871] 74. The method of any of the modalities 49-60 and 64-73, wherein the NHL does not comprise LCBMP and / or the individual administered the cell dose does not comprise LCBMP.
[00872] [00872] 75.The method of any of modalities 57-73, in which the individual is or has been identified as having an Eastern Cooperative Oncology Group Performance Status (ECOG) of 0, 1 or
[00873] [00873] 76.The method of any of the modalities 49-75, in which the individual is or has been identified as having an ECOG status of O or 1.
[00874] [00874] 77.The method of any of the modalities 49-76, in which, at the moment or immediately before the administration of the cell dose, the individual relapsed after remission after treatment with, or became refractory to one or more therapies previous to NHL, optionally one, two or three previous therapies other than another dose of cells that express RAQ.
[00875] [00875] 78.The method of any of the modalities 49-77, in which, on or before the administration of the cell dose: the individual is or has been identified as having a hit doublertriple lymphoma; and / or the individual is or has been identified as having a chemo-refractory lymphoma, optionally a chemo-refractory LDGCB; and / or the individual did not achieve complete remission (CR) in response to previous therapy; and / or the individual relapsed within 1 year or less than 1 year after receiving an autologous stem cell transplant (TACT).
[00876] [00876] 79. The method of any of the modalities 49-78, comprising, prior to the administration of the cell dose, identifying or selecting an individual for the administration of the cell dose that has: a doublertriple hit lymphoma; a chemoreceptive lymphoma, optionally a chemoreceptive LDGCB; did not achieve complete remission (CR) in response to previous therapy for the treatment of malignancy, optionally NHL; and / or relapsed within 1 year or less than 1 year after receiving an autologous stem cell transplant (TACT); and / or has a lymphoma associated with or involving the involvement of the central nervous system (CNS).
[00877] [00877] 80. The method of any of the modalities 49-79,
[00878] [00878] 81. The method of modality 80, wherein the additional therapeutic agent or therapy is for the treatment of NHL or malignancy and / or increases the persistence, activity and / or efficacy of the cell dose.
[00879] [00879] 82.The method of modality 80 or modality 81, in which the therapeutic agent or additional therapy is administered if the individual does not exhibit a response, optionally does not exhibit a CR or RO, to cell therapy within 1 month, within 2 months or within 3 months after administration of the cell dose.
[00880] [00880] 83.The method of modality 80 or modality 81, in which the therapeutic agent or additional therapy is administered to an individual: who is or has been identified as having stable or progressive disease (ED / PD) after treatment with a therapy previous, optionally previous therapy with a chemotherapeutic agent; that is or has been identified with an Eastern Cooperative Oncology Group Performance Status state Eastern Cooperative Oncology Group Performance Status (ECOG) of 2; who is or has been identified as having a transformed follicular lymphoma (tLF); or that is or has been identified as having an LDGCB transformed from MZL and CLL.
[00881] [00881] 84. The method of any of the modalities 80-83, comprising, prior to the administration of the cell dose or the therapeutic agent or additional therapy, identifying or selecting an individual for the administration of the cell dose that has: stable disease or progressive (DE / DP) after treatment with a previous therapy, optionally a previous therapy with a chemotherapeutic agent; an Eastern Cooperative Oncology Group Performance Status (ECOG) of 2; a transformed follicular lymphoma (tLF); or an LDGCB transformed from MZL and CLL.
[00882] [00882] 85.The method of any of the modalities 80-84, wherein the therapeutic agent or additional therapy is administered before, with or at the same time and / or subsequent to the start of the cell dose administration.
[00883] [00883] 86.The method of any of the modalities 49-85, in which: the RAQ comprises an antigen-specific scFv, a transmembrane domain, a cytoplasmic signaling domain derived from a costimulatory molecule, which optionally is or comprises a 4-1BB, and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which optionally is or comprises a CD3zeta signaling domain and optionally further comprises a spacer between the transmembrane domain and the scFv; the RAQ comprises, in order, an antigen-specific scFv, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulatory molecule, which optionally is or comprises a 4-1BB signaling domain and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which optionally is a CD3zeta signaling domain; or the RAQ comprises, in order, an antigen-specific scFv, a spacer, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulating molecule,
[00884] [00884] 87.The method of any of the modalities 49-86, in which the antigen is a B cell antigen, which optionally is CD19.
[00885] [00885] 88.The method of any of modalities 1 - 23 and 49-87, in which, before administration, the individual was preconditioned with a lymphodeplective therapy comprising the administration of fludarabine and / or cyclophosphamide.
[00886] [00886] 89.The method of any of the modalities 1 - 23 and 49-88, further comprising, immediately before administration, the administration of a therapy that complicates lymphodes to the individual who comprises the administration of fludarabine and / or cyclophosphamide.
[00887] [00887] 90. The 88 or 89 method, wherein the lymph node therapy comprises the administration of cyclophosphamide at about 200-400 mg / m , optionally at or about 300 mg / m , Inclusive, and / or fludarabine at about 20-40 mg / m , optionally 30 mg / m , daily for 2-4 days, optionally for 3 days, or where lymph node therapy comprises the administration of cyclophosphamide at about 500 mg / m .
[00888] [00888] 91.The method of mode 88 or mode 89, wherein: lymphodeplective therapy comprises the administration of cyclophosphamide at about 300 mg / m and fludarabine at about 30 mg / m daily for 3 days; and / or lymphodeplective therapy comprises the administration of cyclophosphamide at about 500 mg / m and fludarabine at about 30 mg / m daily for 3 days.
[00889] [00889] 92.The method of any of the modalities 49 to 91, in which the administration of the cell dose and / or the therapy for lymph nodes is performed via ambulatory release, optionally, unless or until the individual has prolonged fever or fever that is either reduced or not reduced by more than 1 ° C after treatment with antipyretic.
[00890] [00890] 93. The method of modality 92, in which if the individual exhibits a prolonged fever or a fever that was or was not reduced or not reduced by more than 1 ºC after treatment with antipyretic, the individual is admitted to the hospital or remains overnight in a hospital and / or an agent or treatment is administered for the treatment or prevention or reduction or mitigation of neurotoxicity and / or cytokine release syndrome or risk thereof.
[00891] [00891] 94.The method of any of the modalities 49-92, wherein the cell dose is administered parenterally, optionally intravenously.
[00892] [00892] 95.The method of any of the modalities 49-94, in which: at least 40% or at least 50% of the individuals treated according to the method achieve complete remission (CR), exhibit progression-free survival (SLP ) and / or overall survival (SG) greater than approximately 3 months, 6 months or 12 months; on average, subjects treated according to the method exhibit a median SLP or SG greater than about 6 months, 12 months or 18 months; and / or the individual exhibits SLP or SG after therapy for at least approximately 6, 12, 18 or more months.
[00893] [00893] 96.The method of any of the modalities 1 - 23 and 49-95, in which, at or about 14 or 28 days after the start of the cell dose administration, the number of RAQ T cells, optionally cells T RAQ * CD8 * and / or T RAQ * CD4 * cells, detectable in the individual's blood, or in most individuals so treated by the method, are greater than 1 cells per uL, greater than 5 cells per uL or greater than 10 cells per uL.
[00894] [00894] 97.The method of any of the modalities 1 - 23 and 49-96, wherein T cells are primary T cells obtained from an individual.
[00895] [00895] 98.The method of any of the modalities 1 - 23 and 49-97, wherein n T cells are autologous to the individual.
[00896] [00896] 99.The method of any of the modalities 1 - 23 and 49-97, in which T cells are allogeneic to the individual.
[00897] [00897] 100. The method of any of the modalities 49-99, wherein the T cells comprise CD4 * T cells that express the RAQ and CD8 * T cells that express the RAQ and the administration comprises administering a plurality of separate compositions,
[00898] [00898] 101.The method of modality 100, in which: the first composition and the second composition are administered with an interval of 0 to 12 hours, an interval of 0 to 6 hours or an interval of 0 to 2 hours or in which the administration of the first composition and the administration of the second composition are carried out on the same day, are carried out between about 0 and about 12 hours apart, between about 0 and about 6 hours or between about 0 and 2 hours apart; and / or initiation of administration of the first composition and initiation of administration of the second composition are carried out between about 1 minute and about 1 hour apart or between about 5 minutes and about 30 minutes apart.
[00899] [00899] 102. The method of mode 100 or mode 101, in which the first composition and the second composition are administered no more than 2 hours, no more than 1 hour, no more than 30 minutes, no more than 15 minutes, no more than 10 minutes or no more than 5 minutes apart.
[00900] [00900] 103. The method of any of the 100-102 modalities, wherein the first composition comprises CD4 * T cells.
[00901] [00901] 104. The method of any of the 100-102 modalities, wherein the first composition comprises CD8 * T cells.
[00902] [00902] 105. The method of any of the modalities 100-104, in which the first composition is administered before the second composition.
[00903] [00903] 106. The method of any of the 49-105 modalities, wherein the dose of T cells is administered to the individual as a single dose or is administered only once within a period of two weeks, one month, three months , six months, 1 year or more.
[00904] [00904] 107. The method of any of the modalities 49-106, wherein the dose of T cells is administered as a double dose, comprising a first dose of T cells and a consecutive dose of T cells, in which one or both of the first dose and the second dose comprises administering the plurality of T cell compositions.
[00905] [00905] 108 The method of modality 107, wherein the consecutive dose is administered at a point in time that is at least or more than about 7 days or 14 days after and less than about 28 days after the administration of first dose of cells.
[00906] [00906] 109. Method for assessing the likelihood of a response to a cell therapy, the method comprising: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample, where the one or more analyzed is selected from ferritin, LDH, CXCL10, G-CSF and IL-10, where: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) individually compare the level, quantity or concentration of the analyzed in the sample with a threshold level, thus determining the probability that an individual will achieve a response to cell therapy.
[00907] [00907] 110. The method of modality 109, further comprising administering cell therapy to the individual if the individual is likely to obtain a response.
[00908] [00908] 111. Method for selecting an individual for treatment, the method comprising: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample, in which the one or more analyzed is selected from ferritin , LDH, CXCL10, G-CSF and IL-10, wherein: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) selecting an individual who is likely to respond to treatment based on the results of determining the likelihood of an individual obtaining a response to cell therapy by individually comparing the level, quantity or concentration of the analyzed in the sample to a threshold level.
[00909] [00909] 112. The method of modality 111, further comprising administering cell therapy to the individual selected for treatment.
[00910] [00910] 113. Treatment method, the method comprising: (a) selecting an individual who is likely to respond to treatment with cell therapy based on the results of determining an individual's likelihood of obtaining a response to cell therapy by individually comparing the level, quantity or concentration of one or more analyzed in a biological sample, where the one or more analyzed is selected from ferritin, LDH, CXCL10, G-CSF and IL-10, to a threshold level, where: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) administering cell therapy to an individual selected for treatment.
[00911] [00911] 114. The method of any of the 109-113 modalities, in which: the individual is likely to get an answer if the level, quantity or concentration of one or more analyzed is below a threshold level and the individual is unlikely to you will get a response if the level, quantity or concentration of one or more of the analyzed is above a threshold level.
[00912] [00912] 115. The method of any of the 109-114 modalities, in which the threshold level is within 25%, within 20%, within%, within 10% or within 5% and / or is within of a standard deviation below the median or average level, quantity or concentration, or is or is above the median or average level, quantity or concentration, of the one analyzed in a biological sample obtained from a group of individuals before receiving cell therapy, in that each individual in the group continued to obtain a response after administration of a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00913] [00913] 116.The method of any of the 109-114 modalities, in which the threshold level is within 25%, within 20%, within%, within 10% or within 5% and / or is within a standard deviation above the median or average level, quantity or concentration of the analyzed in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual in the group started to exhibit stable disease (ED) and / or progressive disease (PD) after administration of a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00914] [00914] 117. The method of any of the 109-116 modalities, in which the answer comprises an objective answer.
[00915] [00915] 118 The method of modality 117, in which the objective response comprises complete response (RC) or partial response (RP).
[00916] [00916] 119. Method for assessing the likelihood of a durable response to cell therapy, the method comprising: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample, where the one or more analyzed is selected from LDH, ferritin, CRP, D-dimer, SAA-1, IL-6, IL-10, IL-15, IL-16, TNF-a, IFN-y, MIP-10, CXCL-10, I1L- 8, MCP-1 and MIP-18, in which: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and
[00917] [00917] 120. The 119 method, further comprising administering cell therapy to the individual, if the individual is likely to achieve a response.
[00918] [00918] 121. Method for selecting an individual for treatment, the method comprising: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample, in which the one or more analyzed is selected from LDH, ferritin , CRP, D-dimer, SAA-1, IL-6, 11-10, IL-15, IL-16, TNF-a, IFN-y, MIP-10, CXCL-10, IL-8, MCP-1 and MIP-18, in which: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) selecting an individual who is likely to respond to treatment based on the results of determining the likelihood that an individual will obtain a durable response to cell therapy by individually comparing the level, quantity or concentration of the analyzed in the sample to a threshold level.
[00919] [00919] 122. The method of modality121, further comprising the administration of cell therapy to the individual selected for treatment.
[00920] [00920] 123. Treatment method, the method comprising: (a) selecting an individual who is likely to respond to treatment with cell therapy based on the results of determining the likelihood that an individual will obtain a durable response to cell therapy by individually comparing the level , quantity or concentration of one or more analyzed in a biological sample with a threshold level, in which the one or more analyzed is selected from LDH, ferritin, CRP, D-dimer, SAA-1, IL-6, I1L-10 , IL-15, IL-16, TNF-a, IFN-y, MIP-10, CXCL-10, IL-8, MCP-1 and MIP-1B, where: the biological sample is from an individual who is a candidate treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) administering cell therapy to an individual selected for treatment.
[00921] [00921] 124. The method of any of the 120-123 modalities, in which: the individual is likely to obtain a durable response if the level, quantity or concentration of one or more analyzed is below a threshold level and the individual is likely it will not achieve a lasting response if the level, quantity or concentration of one or more of the analyzed is above a threshold level.
[00922] [00922] 125. The method of any of the 120-124 modalities, in which the threshold level is within 25%, within 20%, within
[00923] [00923] 126. The method of any of the 120-124 modalities, in which the threshold level is within 25%, within 20%, within 15%, within 11% or within 5% and / or is within a standard deviation above the median or average level, amount or concentration of the analyzed in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual in the group did not achieve a durable response after administration of a therapeutic cell composition that expresses the recombinant receptor to treat the same disease or condition.
[00924] [00924] 127.The method of any of the 120-126 modalities, in which the durable response comprises a complete response (RC) or partial response (RP) that is durable for at least 3 months, 4 months, 5 months or 6 months.
[00925] [00925] 128.The method of any of the 120-127 modalities, in which the durable response comprises an RC or RP that is durable for at least 3 months.
[00926] [00926] 129. Method for assessing the risk of developing toxicity after administration of cell therapy, the method comprising: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample from an individual or a volumetric measurement of tumor load in an individual, in which the one or more analyzed is selected from LDH, ferritin, C-reactive protein (CRP), D-dimer (fibrin degradation product), IL-6, IL-8, IL-10, I1L-15, IL-16 TNF-a, IFN-02, MCP-1, MIP-1a and MIP-18B, in which: the individual is a candidate for treatment with cell therapy, comprising said therapy cell optionally a dose or composition of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) individually compare the level, quantity or concentration of the analyzed in the sample or the volumetric measure of the tumor load with a threshold level, thus determining the risk of developing toxicity after the administration of cell therapy.
[00927] [00927] 130. Method for identifying an individual, the method comprising: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample from an individual or a volumetric measurement of the tumor burden in an individual, where the one or more analyzed is selected from LDH, ferritin, C-reactive protein (PCR), D-dimer (fibrin degradation product), IL-6, IL-8, IL-10, IL-15, IL-16 TNF-a, IFN-a2, MCP-1, MIP-10a and MIP-168, in which: the individual is a candidate for treatment with cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) identify an individual who is at risk of developing toxicity after administering cell therapy based on comparing, individually, the level, quantity or concentration of the analyzed in the sample or the volume measurement of the tumor load at a threshold level .
[00928] [00928] 131. Method of treatment, comprising: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample of an individual or a volumetric measurement of the tumor burden on the individual, in which the one or more analyzed is selected from LDH, ferritin, C-reactive protein (PCR), D-dimer (fibrin degradation product), IL-6, IL-8, IL-10, I1L-15, IL-16 TNF-a, IFN -02, MCP-1, MIP-1a and MIP-18, wherein: the individual is a candidate for treatment with cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) compare, individually, the level, quantity or concentration of the analyzed in the sample or the volumetric measurement of the tumor load with a threshold level, thus determining the risk of developing toxicity after the administration of cell therapy; and (c) following or based on the results of the assessment, administering cell therapy to the individual and, optionally, an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity.
[00929] [00929] 132. The method of any of the modalities 129-131, in which the biological sample is a blood or plasma sample.
[00930] [00930] 133. The method of any of the modalities 129-132, in which the tumor volume volumetric measurement is a sum of the product dimensions (SDP) or is a volumetric measurement based on computed tomography and / or magnetic resonance or another body image.
[00931] [00931] 134. The method of modality 133, in which the volumetric measurement of the tumor load is performed before treatment, before apheresis or before the manufacture of the cellular product.
[00932] [00932] 135. The method of any of the modalities 129-134, further comprising monitoring the individual for symptoms of toxicity if the individual receives cell therapy and is identified as having a risk of developing toxicity.
[00933] [00933] 136.The method of any of the modalities 129-135, in which: the individual is at risk of developing a toxicity if the level, quantity or concentration of one or more analyzed or the volumetric measurement of the tumor load is above a threshold level and the individual has a low risk of developing toxicity if the level, quantity or concentration, one or more analyzed or the volume measurement of the tumor load is below a threshold level.
[00934] [00934] 137. The method of any of the 129-136 modalities, in which the threshold level is within 25%, within 20%, within%, within 10% or within 5% and / or is within of a standard deviation above the median or average level, quantity or concentration, or is or is above the median or average level, quantity or concentration, of the analyzed or the volumetric measurement of the tumor load in a biological sample obtained from a group of individuals before of receiving cell therapy, in which each of the individuals in the group continued to develop no toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00935] [00935] 138. The method of any of the 129-137 modalities, in which the threshold level is within 25%, within 20%, within%, within 10% or within 5% and / or is within of a standard deviation below the median or average level, quantity or concentration of the analyzed or the volumetric measurement of the tumor load in a biological sample obtained from a group of individuals before receiving a cell therapy, in which each individual in the group developed a toxicity after receiving a recombinant drug therapeutic cell composition that expresses the receptor for the treatment of the same disease or condition.
[00936] [00936] 139. The method of any of the modalities 129-138, wherein the toxicity is neurotoxicity or SLC.
[00937] [00937] 140. The method of any of the modalities 129-139, in which the toxicity is neurotoxicity or SLC grade 1 or higher.
[00938] [00938] 141. The method of any of the modalities 129-140, in which: toxicity is severe neurotoxicity or is neurotoxicity grade 2 or higher, neurotoxicity grade 3 or higher, prolonged or at least prolonged grade 3 neurotoxicity or is neurotoxicity grade 4 or 5; or the toxicity is severe SLC or comprises SLC grade 2 or higher or 3 or higher.
[00939] [00939] 142. The method of any of the modalities 129-141, in which the toxicity is neurotoxicity and the volumetric measurement of the tumor load is SDP and the one or more analyzed is selected from among
[00940] [00940] 143. The method of any of the modalities 129-141, in which the toxicity is neurotoxicity and one or more analyzed are evaluated and those analyzed are selected from LDH, Ferritin, CRP, IL-6, IL-8, IL -10, TNF-a, IFN-a2, MCP-1 and MIP-1B.
[00941] [00941] 144. The method of any of the modalities 129-141, in which the toxicity is neurotoxicity and one or more analyzed are evaluated and the analyzed are selected from IL-8, I1L-10 and CXCL10.
[00942] [00942] 145. The 144 method, wherein urotoxicity is severe neurotoxicity or neurotoxicity grade 3 or higher.
[00943] [00943] 146. The method of any of the modalities 129-141, in which the toxicity is SLC and one or more analytical or volumetric measures of the tumor load is selected from LDH, SPD, CRP, d-dimer, IL-6 , IL-15, TNF-a and MIP-1a.
[00944] [00944] 147. The method of modality 146, in which the SLC is a serious SLC or a SLC grade 3 or higher.
[00945] [00945] 148. The method of any of the modalities 129-147, in which if the individual is identified as having a risk of developing toxicity, administering to the individual: (a) (1) an agent or other treatment capable of treating , prevent, delay, reduce or mitigate the development or risk of developing a toxicity and (2) cell therapy, in which administration of the agent must be administered (i) before, (ii) within one, two or three days after, (iii) concomitantly with and / or (iv) in the first fever after the start of administration of cell therapy to the individual; and / or (b) cell therapy at a reduced dose or at a dose that is not associated with the risk of developing serious toxicity or toxicity or that is not associated with the risk of developing severe toxicity or toxicity in most individuals and / or the majority of individuals with a disease or condition that the individual has or is suspected to have after administration of cell therapy; and / or (c) administering cell therapy to the individual in a hospital setting and / or with admission to the hospital for one or more days, optionally in which cell therapy should be administered to individuals on an outpatient basis or without admission to hospital by a or more days.
[00946] [00946] 149. The method of modality 148, wherein the agent or other treatment is an anti-IL-6 antibody or an anti-IL6 receptor antibody.
[00947] [00947] 150. The method of modality 149, wherein the agent or other treatment is or comprises an agent selected from tocilizumab, siltuximab, clazakizumab, sarilumab, olocizumab (CDP6038), elsilimomab, ALD518 / BMS-945429, sirukumabe (CNTO 136 ), CPSI-2634, ARGX-109, FE301 and FM101.
[00948] [00948] 151. The method of modality 148, wherein the agent or other treatment is or comprises a steroid, optionally dexamethasone.
[00949] [00949] 152. The method of any of the modalities 129-142 and 148-151, in which a volumetric measure is evaluated and the volumetric measure is SDP and the threshold level is or is about 30 cm , is it or is it about 40 cm , is it or is it about 50 cm , is it or is it about 60 cm , or is it or is it about 70 cm .
[00950] [00950] 153. The method of modality 152, in which the volumetric measure is SDP and the threshold level is or is about 50 cm .
[00951] [00951] 154. The method of any of the modalities129-151, in which the one or more analyzed is or comprises LDH and the threshold level is or is about 300 units per liter, is or is about 400 units per liter, is either about 500 units per liter or is or is about 600 units per liter.
[00952] [00952] 155. The method of any of the modalities 154, in which the analyzed is LDH and the threshold level is or is about 500 units per liter.
[00953] [00953] 156.The method of any of the modalities 109-155, wherein the recombinant receptor specifically binds to an antigen associated with the disease or condition or expressed in cells of the environment of an injury associated with the disease or condition.
[00954] [00954] 157. The method of any of the modalities 109-156, in which the disease or condition is a cancer.
[00955] [00955] 158. The method of any of the modalities 109-157, in which the disease or condition is a myeloma, leukemia or lymphoma.
[00956] [00956] 159. The method of any of the modalities 109-158, in which the disease or condition is a B cell neoplasm and / or is adult acute lymphoblastic leukemia (ALL), chronic lymphoblastic leukemia (LLC), lymphoma non-Hodgkin (NHL) and Diffuse Large B Cell Lymphoma (LDGCB).
[00957] [00957] 160. The method of any of the 109-159 modalities, wherein the recombinant receptor is a chimeric antigen (RAQ) receptor.
[00958] [00958] 161.The method of any of the modalities 109-160, wherein the modified cells comprise T cells, optionally CD4 * and / or CD8 *.
[00959] [00959] 162. The 161 method, wherein T cells are primary T cells obtained from an individual or are autologous to the individual.
[00960] [00960] 163. Method for selecting an individual for treatment, the method comprising: (a) contacting a biological sample with one or more reagents capable of detecting or that is specific for one or more analyzed, in which the one or more most analyzed is selected from LDH, ferritin, CRP, IL-6, IL-7, IL-8, I1L-10, I1L-15, IL-16, TNF-alpha, IFN-gamma, MCP-1, MIP-1beta , eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, IP-10, perforin, and D-dimer (fibrin degradation product), in which: the biological sample is from an individual who is a candidate for treatment with a therapy cell, said cell therapy optionally comprising a dose or composition of genetically modified cells expressing a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) select an individual in which: (i) the level, quantity or concentration of the analyzed in the sample is equal to or higher than a threshold level, thus identifying an individual who is at risk of developing toxicity for cell therapy; or (ii) the level, quantity or concentration of the analyzed is below a threshold level.
[00961] [00961] 164. The 163 method, in which: (a) an individual in (i) is selected to administer to the individual (1) an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating development or risk of developing a toxicity and (2) the therapy cell, in which administration of the agent must be administered (i) before, (ii) within one, two or three days after, (ili) concomitantly with and / or (iv) in the first fever after the start of the administration of cell therapy for the individual; and / or (b) an individual in (i) is selected to give the individual cell therapy at a reduced dose or at a dose that is not associated with the risk of developing toxicity or severe toxicity, or is not associated with the risk of developing a severe toxicity or toxicity in most individuals and / or most individuals with a disease or condition that the individual has or is suspected to have after administration of cell therapy; and / or (c) an individual in (i) is selected to administer to the individual cell therapy in a hospital setting and / or with admission to the hospital for one or more days, optionally where cell therapy is otherwise to be administered to patients on an outpatient basis or without admission to the hospital for one or more days.
[00962] [00962] 165. The 163 or 164 method, in which an individual in (i) is selected and the method further comprises: (a) administering to the individual (1) an agent or other treatment capable of treating, preventing, delay, reduce or mitigate the development or risk of developing a toxicity and (2) cell therapy, in which administration of the agent is carried out (i) before, (ii) within one, two or three days after, ( iii) concomitantly with and / or (iv) in the first fever after the start of administration of cell therapy to the individual; and / or (b) giving the individual cell therapy at a reduced dose or at a dose that is not associated with the risk of developing serious toxicity or toxicity, or is not associated with the risk of developing severe toxicity or toxicity in most individuals, and / or the majority of individuals with a disease or condition that the individual has or is suspected to have after administration of cell therapy; and / or (c) administering to the individual cell therapy or a dose of genetically modified cells from cell therapy that is not associated with the risk of developing serious toxicity or toxicity, or is not associated with the risk of developing serious toxicity or toxicity in a majority of individuals and / or a majority of individuals with a disease or condition that the individual has or is suspected to have after administration of cell therapy; and / or (d) giving the individual cell therapy in a hospital setting and / or with admission to the hospital for one or more days, optionally in which cell therapy should be administered otherwise to individuals on an outpatient basis or without admission to hospital for one or more days.
[00963] [00963] 166. The 163 or 164 method, in which: (a) an individual in (ii) is selected to administer to the individual cell therapy, optionally in a reduced dose, optionally on an outpatient basis or without admission to the hospital for one or more days; (b) an individual in (ii) is selected to administer to the individual cellular therapy, in which the cellular therapy does not comprise the administration, before or simultaneously with the administration of the cellular therapy and / or before the development of a sign or symptom of a toxicity other than fever, an agent or treatment capable of treating, preventing, delaying or mitigating the development of toxicity; and / or (c) an individual in (ii) is selected to administer cell therapy in an outpatient setting and / or without admission of the individual to the hospital overnight or for one or more consecutive days and / or does not admit the individual to the hospital for one or more days.
[00964] [00964] 167.The 163, 164 or 166 modality method, in which an individual in (ii) is selected, and the method further comprises administering to the individual cell therapy, optionally in a non-reduced dose, optionally on an outpatient basis or without hospitalization for one or more days.
[00965] [00965] 168.The method of any of the modalities 163, 164, 166 and 167, in which an individual in (ii) is selected, and the method further comprises administering to the individual cell therapy, in which: the administration of therapy cellular does not include administering, before or simultaneously with the administration of cell therapy and / or before the development of a sign or symptom of toxicity other than fever, an agent or treatment capable of treating, preventing, delaying or mitigating the development of toxicity; and / or the administration of cell therapy should be or can be administered to the patient on an outpatient basis and / or without admission of the patient to the hospital overnight or for one or more consecutive days and / or without admission of the patient to the hospital hospital for one or more days.
[00966] [00966] 169. Treatment method, comprising: (a) testing a biological sample for the level, quantity or concentration of one or more analyzed, in which the biological sample is from an individual who is a candidate for treatment, optionally with a therapy cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells that express a recombinant receptor for the treatment of a disease or condition, wherein the one or more analyzed is selected from LDH, ferritin, CRP, IL-6 , IL-7, IL-8, 11-10, I1L-15, I1L-16, TNF-alpha, IFN-gamma, MCP-1, MIP-1beta, eotaxin, G-CSF, IL-1Ralpha, IL-1Rbeta , I1P-10, perforin and D-dimer (fibrin degradation product); and (b) following or based on the test results,
[00967] [00967] 170. Method of treating an individual with or suspected of having a disease or condition, the method comprising: (1) administering to the individual a cell therapy comprising a dose or genetic engineering composition that expresses a recombinant receptor for treatment or that specifically recognizes the disease or condition and, optionally, (2) further administer to the individual an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity, in which: administration is performed below or is performed in a manner based on the results of the assessment of one or more pre-treatment parameters, in which: (a) the one or more pre-treatment parameters comprise a parameter associated or correlated with, or which is a substitute for the burden of disease or condition on the individual, whose parameters optionally comprise one or more analyzed and / or one or more volumetric or other measurement of color po, (b) the evaluation of one or more pre-treatment parameters comprises the evaluation of a quantity or level of, in a biological sample that is or is from a sample obtained from the individual, a level, quantity or concentration of one or most analyzed, the biological sample is obtained from the individual before administration of cell therapy, where the sample is obtained from the individual before administration of cell therapy and, optionally, before apheresis or before the manufacture of cells for administration and / or one or more analyzed is associated with the disease burden and / or the one or more analyzed is selected from LDH, ferritin, PCR, IL-6, IL-7, IL-7, IL-8, IL-10, IL -15, IL-16, TNF-alpha, IFN-gamma, MCP-1, MIP-1beta, eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, IP-10, perforin and D-dimer (degradation product of fibrin); and / or (c) the evaluation of one or more pre-treatment parameters optionally comprises the evaluation of a volumetric measure of the disease or condition in the individual, which is optionally a measure obtained by image, optionally a sum of the product dimensions (SDP ), or other volumetric measurements, optionally based on computed tomography and / or magnetic resonance images or other images of the body, taken before treatment and, optionally, before apheresis or cell manufacture.
[00968] [00968] 171. The method of modality 170, in which said evaluation of one or more pre-treatment parameters comprises the analysis of one or more analyzed, which comprises detection which optionally comprises the contact of a reagent capable of directly or directly detecting indirectly the one (s) analyzed with the biological sample and determination of the level, quantity or concentration of the one (s) analyzed in the biological sample.
[00969] [00969] 172. The method of modality 170 or modality 171, in which the evaluation of one or more pre-treatment parameters comprises (A) the evaluation of, in a biological sample that is or is from a sample obtained from the individual before of treatment and / or before apheresis or cell processing, a level, quantity or concentration of one or more analyzed, optionally associated with disease burden, and (B) evaluation of a volumetric measure of disease burden, in which the measure of disease burden is optionally a sum of the result product of dimensions (SDP), or other volumetric measurements, optionally based on CT and / or MRI images or other images of the body and / or are taken before treatment, apheresis or manufacturing of the cellular product.
[00970] [00970] 173. The method of any of the 169-172 modalities, in which, if the level, quantity or concentration and / or measure, or combination thereof, resulting from or from the pre-treatment assessment, is equal to or greater than a threshold: the administration comprises the additional administration to the individual of the agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity, optionally, in which the additional administration is carried out (i) before (ii) within one, two or three days after, or within four five or six days after, (iii) concomitantly with and / or (iv) in the first fever after the start of the administration of cell therapy to the individual; and / or the cell therapy administered to the individual is administered (A) in a reduced dose compared to whether the level, quantity or concentration and / or measure, or combination thereof, is below the threshold level, or (B) in a dose that is not associated with the risk of developing serious toxicity or toxicity or is not associated with the risk of developing serious toxicity or toxicity in most individuals and / or most individuals with a disease or condition that the individual has or is suspected of having , after administration of cell therapy, or (C) in a reduced dose compared to the maximum tolerated dose or the approved dose or the maximum approved dose, for use in individuals with the disease or condition or for the treatment of the disease or condition; and / or the administration of the cell therapy to the individual is carried out or is specified to be carried out in a hospital environment and / or with admission to the hospital for one or more days, optionally in which the cell therapy is different, if the level, quantity, concentration , measure or combination is below the limit or is not evaluated, to be administered to outpatients or without admission to the hospital for one or more days or overnight.
[00971] [00971] 174. The method of any of the modalities 169-173, in which, if the level, quantity or concentration and / or measure, or combination of them, resulting from or obtained through the pre-treatment evaluation, is below a threshold level: the administration of cell therapy does not include the administration, before or simultaneously with the administration of cell therapy and / or before the development of a sign or symptom of a toxicity other than fever, an agent or treatment capable of treating, preventing, delay or mitigate the development of toxicity; and / or the administration of cell therapy should be, or can be, administered to the patient on an outpatient basis and / or without admission of the patient to the hospital overnight or for one or more consecutive days and / or without admission of the patient to the hospital for one or more days; and / or cell therapy administered to the individual is administered (A) in a dose, optionally, an amount of T cells or modified T cells or T cells of a specified phenotype, which is greater than what would be administered if the level, amount or concentration and / or measurement, or combination thereof, equal to or greater than the threshold, or (B) in a dose, optionally, an amount of T cells or modified T cells or T cells of a specified phenotype, which is or is approximately the maximum tolerated dose or the maximum dose approved for use in treating individuals with the disease or condition.
[00972] [00972] 175. Method of prophylactic treatment, which includes the administration, to an individual, of an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity, in which:
[00973] [00973] 176. The method of modality 175, in which said assay comprises detection that optionally comprises the contact of a reagent capable of directly or indirectly detecting the analyte with the biological sample and determining the level, quantity or concentration of the analyte in the sample biological and / or in which the agent is administered to the individual if the level, quantity or concentration of the analyzed in the sample is at a threshold level or above and, optionally, in which the agent is administered (i) before, (ii) within one, two or three days, (iii) concomitantly with and / or (iv) the first fever after the start of administration of cell therapy to the individual.
[00974] [00974] 177.The method of modality 175 or modality 176, in which the evaluation of one or more pre-treatment parameters comprises (A) the evaluation of, in a biological sample that is or is from a sample obtained from the individual before of treatment and / or before apheresis or cell processing, a level, quantity or concentration of one or more analyzed, optionally associated with disease burden, and (B) evaluation of a volumetric measure of disease burden, in which the measure of disease burden is optionally a sum of the result product of dimensions (SDP), or other volumetric measurements, optionally based on CT and / or MRI images or other images of the body and / or are taken before treatment, apheresis or manufacturing of the cellular product.
[00975] [00975] 178. The method of any of the 169-177 modalities, in which the threshold level is within 25%, within 20%, within%, within 10% or within 5% of the average level, quantity or concentration or measure and / or is within a standard deviation of the mean level, quantity or concentration or measure of the analyzed or parameter in a biological sample obtained from a group of individuals before receiving a therapeutic cell composition that expresses the recombinant receptor, in that each individual in the group developed toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[00976] [00976] 179. The method of any of the modalities 169-178, in which the reagent is a binding molecule that specifically binds to the analyzed.
[00977] [00977] 180. The method of any of the modalities 169-179, in which the reagent is an antibody or an antigen-binding fragment thereof.
[00978] [00978] 181. The method of any of the modalities 169-180, in which the biological sample is or is obtained from a blood, plasma or serum sample.
[00979] [00979] 182. The method of any of the modalities 169-181, in which, when analyzing or evaluating the cells, the analyzed comprises an immunoassay.
[00980] [00980] 183. The method of any of the modalities 169-182, wherein the toxicity comprises neurotoxicity or cytokine release syndrome (SLC), optionally neurotoxicity or SLC grade 1 or higher.
[00981] [00981] 184. The method of any of the modalities 169-183, wherein: the toxicity comprises severe neurotoxicity and / or comprises a neurotoxicity grade 2 or higher, a neurotoxicity grade 3 or higher, at least one prolonged grade 3 neurotoxicity or is equal to or greater than grade 4 or 5 neurotoxicity; and / or the toxicity comprises severe SLC and / or comprises SLC grade 2 or higher or SLC grade 3 or higher.
[00982] [00982] 185. The method of any of the modalities 169-184,
[00983] [00983] 186.The method of any of the modalities 169-185, wherein the agent or other treatment is or comprises one or more steroids; a cytokine or cytokine receptor antagonist or inhibitor selected from IL-10, IL-10R, IL-6, IL-6 receptor, IFNy, IFNGR, 1L-2, IL-2R / CD25, MCP-1, CCR2 , CCR4, MIP1IB, CCRS5, TNFalpha, TNFR1, IL-1 and IL-1Ralfa / IL-1beta; or an agent capable of preventing, blocking or reducing the activity or function of microglial cells.
[00984] [00984] 187. The method of modality 186, wherein the antagonist or inhibitor is or comprises an agent selected from an antibody or antigen-binding fragment, a small molecule, a protein or peptide and a nucleic acid.
[00985] [00985] 188. The method of any of the modalities 169-187, wherein the agent or other treatment is an anti-IL-6 antibody or an anti-IL6 receptor antibody.
[00986] [00986] 189. The method of any of the modalities 169-188, in which the agent or other treatment is or comprises a selected agent - among tocilizumab, siltuximab, clazakizumab, sarilumab, olokizumab (CDP6038), elsiimomabe, ALD518 / BMS- 945429, sirukumab (CNTO 136), CPSI-2634, ARGX-109, FE301 and FM101.
[00987] [00987] 190. The method of any of the modalities 169-189, wherein the agent or other treatment is or comprises tocilizumab.
[00988] [00988] 191. The method of any of the modalities 169-190, wherein the agent or other treatment is or comprises siltuximab.
[00989] [00989] 192. The method of modality 186, wherein the steroid is or comprises dexamethasone.
[00990] [00990] 193. The method of modality 186, in which the agent capable of preventing, blocking or reducing the activity or function of microglial cells is selected from an anti-inflammatory agent, a NADPH oxidase (NOX2) inhibitor, a calcium channel blocker, a sodium channel blocker, inhibits GM-CSF, inhibits CSFI1R, specifically binds to CSF-1, specifically binds to IL-34, inhibits the activation of nuclear factor cover B (NF- <B), activates a CB2 receptor and / or is a CB2 agonist, a phosphodiesterase inhibitor, inhibits microRNA-155 (miR-155) or up-regulates microRNA-124 (MIR-124).
[00991] [00991] 194. The method of modality 193, wherein the agent capable of preventing, blocking or reducing the activation or function of microglial cells is a small molecule, peptide, protein, antibody or antigen-binding fragment, a mimetic antibody, an aptamer or a nucleic acid molecule.
[00992] [00992] 195. The 193 or 194 modality method, in which the agent is selected from minocycline, naloxone, nimodipine, Riluzole, MOR103, lenalidomide, a cannabinoid (optionally WIN55 or 212-2), intravenous immunoglobulin (IVlg), ibudilast, anti-miR-155 blocked nucleic acid (LNA), MCS110, PLX-3397, PLX647, PLX108-D1, PLX7486, JNJ-40346527, JNJ28312141, ARRY-382, AC-708, DCC-3014, 5- (3 -methoxy-4 - (((4-methoxybenzyl) oxy) benzyl) pyrimidine-2,4-diamine (GW2580), AZD6495, Ki20227, BLZ945, emactuzumab, IMC-CS4, FPAOO8, LY-3022855, AMG-820 and TG- 3003.
[00993] [00993] 196. The method of any of the modalities 193-195, in which the agent is an inhibitor of the colony stimulating factor 1 receptor (CSF1IR).
[00994] [00994] 197. The method of any of the modalities 193-196, in which the agent is selected from: PLX-3397, PLX647, PLX108-D1, PLX7486, JNJ-40346527, JNJ28312141, ARRY-382, AC-708, DCC-3014, 5- (3-methoxy-4 - ((4-methoxybenzyl) oxy) benzyl) pyrimidine-2,4-diamine (GW2580), AZD6495,
[00995] [00995] 198. The method of any of the modalities 193-197, in which the inhibitor is PLX-3397.
[00996] [00996] 199. The method of any of the modalities 1 - 23 and 109-198, in which the recombinant receptor specifically binds to an antigen associated with the disease or condition or expressed in the cells of the environment of an injury associated with the disease or condition .
[00997] [00997] 200. The method of any of the modalities 1 - 23 and 109-199, in which the disease or condition is a cancer.
[00998] [00998] 201.The method of any of the modalities 1 - 23 and 109-200, in which the disease or condition is a myeloma, leukemia or lymphoma.
[00999] [00999] 202. The method of any of the modalities 1 - 23 and 109-201, in which the disease or condition is a B-cell malignancy and / or is acute lymphoblastic leukemia (ALL), adult ALL, chronic lymphoblastic leukemia (LLC), non-Hodgkin lymphoma (NHL) and diffuse large B cell lymphoma (LDGCB).
[001000] [001000] 203. The method of any of the modalities 1 - 23 and 109-202, in which the antigen is ROR1, B cell maturation antigen (AMCB), carbonic anhydrase 9 (CAIX), tEGFR, Her2 / neu ( tyrosine kinase receptor erbB2), L1 -CAM, CD19, CD20, CD 22, mesothelin, CEA and hepatitis B surface antigen, antifolate receptor, CD23, CD24, CD30, CD30, CD33, CD38, CD44, EGFR, glycoprotein 2 epithelial (GEP-2), epithelial glycoprotein 40 (GEP-40), EPHa2 dimers, erb-B2, erb-B3, erb-B4, erbB, EGFR vill, folate-binding protein (FBP), FCRL5, FCRHS5, receptor fetal acetylcholine, GD2, GD3, HMW-MAA, IL-22R-alpha, IL-13R-alpha2, kinase insertion domain receptor (Kdr), kappa light chain, Lewis Y, L1 cell adhesion molecule, ( LI-CAM), melanoma-associated antigen (MAGE) -A1, MAGE-A3, MAGE-A6, preferentially expressed melanoma antigen (AMEPE), survivin, TAG72, B7-H6, IL-13 alpha 2 receptor (IL- 13Ra2), CA9, GD3, HMW-MAA, CD171, G250 / CAIX, HLA-AI MAGE Al, HLA-A2 NY-ESO-1 , PSCA, folate receptor-a, CD44v6, CD44v7 / 8, integrin avb6, 8H9, NCAM, VEGF receptors, 5T4, fetal AchR, NKG2D, CD44v6 ligands, double antigen, cancer tester antigen, mesothelin, murine CMV, mucin 1 (MUC1), MUC16, PSCA, NKG2D, NY-ESO-1, MART-1, gp100, antigen - oncofeta, —ROR1, TAG / 2, VEGF-R2, carcinoembryonic antigen (CEA), Her2 / neu, receptor estrogen, progesterone receptor, ephrinB2, CD123, c-Met, GD-2, O-acetylated GD2 (GD20), CE7, Wilms' tumor 1 (WT-1), a cyclin, cyclin A2, CCL-1, CD138, Receptor Coupled to Protein G 5D (RAPG5D) or a specific pathogen antigen.
[001001] [001001] 204. The method of any of modalities 1 - 23 and 109-203, wherein the recombinant receptor is a T cell receptor or a functional non-T cell receptor.
[001002] [001002] 205. The method of any of the modalities 1 - 23 and 109-204, wherein the recombinant receptor is a chimeric antigen (RAQ) receptor.
[001003] [001003] 206. The 205 mode method, wherein the RAQ comprises an extracellular antigen recognition domain that specifically binds to the antigen and an intracellular signaling domain comprising an ITAM, where optionally, the intracellular signaling domain comprises a intracellular domain of a CD3-zeta chain (CD37); and / or wherein the RAQ further comprises a co-stimulating signaling region, which optionally comprises a CD28 or 4- signaling domain
[001004] [001004] 207. The method of any of modalities 1 - 23 and 109-206, wherein the modified cells comprise T cells, optionally CD4 * and / or CD8 *.
[001005] [001005] 208. The 207 method, wherein T cells are primary T cells obtained from an individual.
[001006] [001006] 209. The method of any of the modalities 1 - 23 and 109-208, wherein the cell therapy comprises the administration of or from about 1 x 10 to 1 x 108 expression cells of total recombinant receptors, T cells total or peripheral whole blood mononuclear cells (PBMC), from or from about 5 x 10 to 1 x 107 total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMC) or from or about from 1 x 10º to 1 x 107 total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMC), each inclusive.
[001007] [001007] 210. The method of any of the modalities 1 - 23 and 109-209, wherein the cell therapy comprises the administration of no more than 1 x 108º cells of expression of total recombinant receptors, total T cells or mononuclear cells of total peripheral blood (PBMC), no more than 1 x 107 total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMC), no more than 0.5 x 107 receptor expression cells total recombinants, total T cells or total peripheral blood mononuclear cells (PBMCs), no more than 1 x 10th total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMCs), no more than 0.5 x 10 th total recombinant receptor expression cells, total T cells or total peripheral blood mononuclear cells (PBMC).
[001008] [001008] 211. The method of any of the 109-210 modalities, in which the dose that is not associated with the risk of developing toxicity or severe toxicity is or comprises less than or less than about 5 x 10 ”expression cells. total recombinant receptors, optionally RAQ * cells, total T cells or total peripheral blood mononuclear cells (PBMC), as less than or less than about 2.5 x 10 ”, less than or less than about 1.0 x 10 ”, Smaller or smaller than 5.0 x 108, smaller or smaller than about 1.0 x 106, smaller or smaller than about 5.0 x 105 or smaller or equal to about 1 x 105º cells expression of total recombinant receptor, optionally RAQ cells ”, total T cells or total peripheral blood mononuclear cells (PBMC).
[001009] [001009] 212. The method of any of the 109-211 modalities, wherein the dose that is not associated with the risk of developing serious toxicity or toxicity is or comprises of or from about 1 x 10 to 5 x 107 expression cells of total recombinant receptors, optionally RAQ + cells, total T cells or total peripheral blood mononuclear cells (PBMC), such as 1 x 10 th to 2.5 x 107, 1x 10 th to 1.0 x 107, 1 x 10 th to 5.0 x 106, 1 x 10º to 1.0 x 108, 1.0 x 10º to 5.0 x 10º, 5.0 x 10º to 5x 107, 5x 10º to 2.5x 107, 5x 10º to 1.0 x 107, 5x 10º to 5.0 x 108, 5x 10º to 1.0 x 106, 1.0 x 10º to 5x 107.1 x 10º to 2.5x 107, 1 x 10º to 1.0 x 107, 1 x 10º to 5.0 x 106, 5.0 x 10 to 5x 107, 5x 106 to 2.5 x 107, 5x 106 to 1.0 x 107, 1.0 x 107 to 5x 107, 1 x 107 to 2.5 x 107 or 2.5 x 107 to 5 x 107 total recombinant receptor expression cells, optionally RAQ cells ”, total T cells or total peripheral blood mononuclear cells (PBMCs))
[001010] [001010] 213. The method of any of the modalities 109-212, in which the modified cells are autologous to the individual.
[001011] [001011] 214. The method of any of the modalities 109-213,
[001012] [001012] 215. The method of any of the modalities 109-214, in which the reagent is detectably labeled, optionally marked by fluorescence.
[001013] [001013] 216. The method of any of the modalities 163-215, in which the one or more analyzed is LDH, ferritin, CRP, IL-6, IL-8, IL-10, TNF-alpha, IFN-alpha2, MCP-1 and MCP-1beta.
[001014] [001014] 217. The method of any of the 163-215 modalities, in which the one or more analyzed is selected from LDH, ferritin, CRP, IL-6, I1L-8, 1L-8, 11-10, TNF-a, MCP-1 and MIP-1beta, and the toxicity is neurotoxicity.
[001015] [001015] 218. The method of any of the 163-215 modalities, in which the one or more analyzed is selected from IL-8 and IL-10 and the toxicity is neurotoxicity, optionally severe neurotoxicity or grade 3 or higher neurotoxicity .
[001016] [001016] 219. The method of any of the 163-215 modalities, in which the one or more analyzed is selected from LDH, Ferritin, C-reactive protein (PCR), D-dimer (fibrin degradation product), IL- 6, IL-10, IL-15, IL-16 TNF-a, MIP-1a and MIP-18 and the toxicity is SLC or neurotoxicity.
[001017] [001017] 220. The method of any of the modalities 109-219, in which the one or more analyzed is or comprises LDH.
[001018] [001018] 221. Article of manufacture comprising one or more doses of a cell therapy, each dose comprising cells expressing a chimeric antigen receptor (RAQ) and instructions for administering the cell therapy, where the instructions specify that: the dose of cells should be administered to an individual with or identified as having non-Hodgkin's lymphoma (NHL), the NHL selected from diffuse large B-cell lymphoma
[001019] [001019] 222. The article of manufacture of modality 221, in which the instructions specify the administration of cell therapy to a defined ratio of CD4 * cells that express RAQ to CD8 * cells or specify the administration of volume quantities of (s) ) formulation (s) corresponding to that defined relationship, either comprise a formulation with cells in that relationship or comprise cells in that relationship that express the RAQ and / or CD4 * cells to CD8 * cells, the relationship of which is optionally approximately 1: 1 or between approximately 1: 3 and approximately 3: 1.
[001020] [001020] 223. Article of manufacture comprising a cell therapy, or one of a plurality of cell therapy compositions, comprising a dose or composition of genetically modified cells expressing a chimeric antigen receptor (RAQ), and instructions for administering cell therapy, where the instructions specify: the dose of T cells should be administered in a defined ratio of CD4 * cells expressing RAQ to CD8 * cells expressing RAQ and / or CD4 * cells to CD8 * cells, whose ratio is approximately or is 1: 1, and the cell dose should be administered to an individual with or identified as having non-Hodgkin's lymphoma (NHL), the NHL selected from diffuse large B-cell lymphoma (LDGCB ), primary mediastinal B-cell lymphoma (LCBMP), NOS (again or transformed from indolent lymphoma) or Grade 3B follicular lymphoma.
[001021] [001021] 224. Article of manufacture comprising a cell therapy, or one of a plurality of cell therapy compositions, comprising a dose or composition of genetically modified cells expressing a chimeric antigen (RAQ) receptor and instructions for administering the cell therapy, where the instructions specify: the cell dose should be administered to an individual with or identified as having non-Hodgkin's lymphoma (NHL), optionally an NHL selected from aggressive NHL, diffuse large B-cell lymphoma ( LDGCB), NOS (again and turned into indolent), primary mediastinal large B cell lymphoma (LCBMP), lining cell lymphoma (CSF) and / or follicular lymphoma (LF), optionally Grade 3B follicular lymphoma (LF3B); the dose of T cells to be administered comprises between about 5 x 10º RAQ expression T cells and 1 x 10º RAQ expression T cells, inclusive; and the T cell dose should be administered in a defined ratio of CD4 * cells that express the RAQ to CD8 * cells that express the RAQ and / or from CD4 * cells to CD8 * cells, the ratio of which is approximately or is 1: 1.
[001022] [001022] 225. The article of manufacture of modality 222 or modality 223, in which the instructions further specify that cell therapy should be administered to an individual who is or has been identified as having an Eastern Cooperative Oncology Group Performance Status (ECOG) 0, 1 or 2 and / or which is or has been identified as having an ECOG status of 0 or 1.
[001023] [001023] 226. The article of manufacture of any of the modalities 221-225, in which: the instructions specify that the administration is for an individual who has not received, immediately before the administration of the cell dose or within or approximately one month from the dose of cells, an agent or treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing toxicity; and / or the instructions do not specify that administration to an individual who, prior to commencing cell dose administration, received an anti-IL-6 or anti-| L-6R antibody, optionally tocilizumab or siltuximab, and / or a steroid, optionally dexamethasone, was not administered; and / or the instructions do not specify the administration of an agent that is an anti-IL-6 or anti-| IL-6R antibody, optionally tocilizumab or siltuximab, a steroid, optionally dexamethasone and / or an agent for the purpose of prophylactically reducing the risk of either treatment for SLC or neurotoxicity and / or does not specify the administration of said agent within a period of time after administration of the cell dose, optional period of approximately 1, 2, 3, 4, 5 days or optionally at or about 6, 7, 8, 9, 10, 11 days or, optionally, 1, 2, 3 or 4 weeks and / or does not specify the administration of said agent prior to the individual's display, or unless the individual has a sign or symptom of neurotoxicity and / or SLC, optionally other than fever, optionally where the fever is not a prolonged fever or the fever is or has been reduced or reduced by more than 1 ° C after treatment with antipyretic; and / or the instructions specify the administration of the cell dose on an outpatient basis and / or without the patient's admission to a hospital and / or without an overnight stay in the hospital and / or without the need for admission or overnight stay in the hospital, optionally, unless the risk factor specific to the individual or to the individual's cells is identified otherwise in the instructions or information in the article or optionally, unless or until the individual experiences prolonged fever or reduced or not reduced or reduced fever by more than 1 ºC after antipyretic treatment.
[001024] [001024] 227. The article of manufacture of modality 226, in which the instructions further specify that if, after administering the cell dose on an outpatient basis, without the need for admission or overnight stay in a hospital, the individual will display prolonged fever or fever that is either not reduced or has not been reduced by more than 1 ° C after treatment with antipyretic, the individual must be admitted to the hospital or overnight in the hospital and / or an agent or treatment should be administered for the treatment or preventing or reducing or mitigating a neurotoxicity and / or cytokine release syndrome or risk of it.
[001025] [001025] 228. The article of manufacture of modality 226 or modality 227, wherein the agent is or comprises an anti-IL-6 or anti-IL-6R antibody, optionally tocilizumab or siltuximab, and / or a steroid, optionally dexamethasone .
[001026] [001026] 229. The article of manufacture of any of the modalities 221-228, in which the instructions specify that the individual has an LDGCB characterized as new or transformed from an indolent disease and / or does not have an LDGCB transformed to from MZL and CLL (Richter).
[001027] [001027] 230. The article of manufacture of any of the modalities 221-229, in which the instructions specify the individual does not have primary mediastinal large B-cell lymphoma (LCBMP).
[001028] [001028] 231. The article of manufacture of any one of the modalities 221-230, in which the instructions specify the administration of cells to an individual who is or has been identified as having an associated lymphoma or involving the involvement of the central nervous system (CNS) ).
[001029] [001029] 232. The article of manufacture of any of the modalities 221-231, in which the instructions specify the administration of cell therapy is for an individual who is or has been identified as having a double / triple stroke lymphoma, is or has been identified as having a chemoreceptive lymphoma, optionally a chemoreceptive LDGCB; who did not achieve complete remission (CR) in response to previous therapy; and / or relapsed within 1 year or less than 1 year after receiving an autologous stem cell transplant (TACT).
[001030] [001030] 233. The article of manufacture of any of the modalities 221-232, wherein the instructions specify the additional administration to an individual of a therapeutic agent or additional therapy, optionally different from a cell therapy, optionally different from cell therapy TRAQ *.
[001031] [001031] 234. The article of manufacture of modality 233, in which the therapeutic agent or additional therapy is an agent for the treatment of NHL or malignancy and / or increases the persistence, activity and / or effectiveness of the cell dose.
[001032] [001032] 235. The article of manufacture of modality 233 or modality 234, in which the instructions specify the administration of the therapeutic agent or additional therapy is in an individual who does not exhibit a response, optionally does not exhibit an RC or RO, to cell therapy within 1 month, within 2 months or within 3 months after administration of the cell dose.
[001033] [001033] 236. The article of manufacture of any of the modalities 233-235, in which the instructions specify the administration of the therapeutic agent or additional therapy is in an individual: who is or has been identified as having stable or progressive disease (DE / PD) after treatment with a previous therapy, optionally a previous therapy with a chemotherapeutic agent; that is or has been identified with an Eastern Cooperative Oncology Group Performance Status (ECOG) of 2; who is or has been identified as having a transformed follicular lymphoma (tLF); or that is or has been identified as having an LDGCB transformed from MZL and CLL.
[001034] [001034] 237. The article of manufacture of any of the modalities 233-236, in which the instructions specify the therapeutic agent or additional therapy for administration before, with or at the same time and / or subsequent to the beginning of the administration of the cell dose .
[001035] [001035] 238. The article of manufacture of any one of the modalities 221-237, in which the RAQ comprises a scFv specific for the antigen, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulating molecule, which optionally is a 4 -1BB and a cytoplasmic signaling domain derived from a primary signaling molecule containing ITAM, which is optionally a CD3zeta.
[001036] [001036] 239. The article of manufacture of any of the modalities 221-238, in which the antigen is a B cell antigen, which optionally is CD19.
[001037] [001037] 240. The article of manufacture of any of the modalities 221-239, further comprising instructions for use with, after or in connection with a lymph node elimination therapy, the lymphatic elimination therapy optionally comprising fludarabine and / or cyclophosphamide .
[001038] [001038] 241. The article of manufacture of modality 240, in which the therapy for lymph nodes comprises the administration of cyclophosphamide at about 200-400 mg / m , optionally at or about 300 mg / m , Inclusive, and / or fludarabine at about 20-40 mg / m , optionally mg / m , daily for 2-4 days, optionally for 3 days.
[001039] [001039] 242. The article of manufacture of modality 240 or modality 241, in which the lymphodeplective therapy comprises the administration of cyclophosphamide at or about 300 mg / im and fludarabine at about 30 mg / m daily for 3 days.
[001040] [001040] 243. The article of manufacture of any of the modalities 221-242, in which the instructions further specify that the administration of cell therapy must be or can be administered to the individual in an outpatient setting and / or without admission of the individual to the hospital overnight or for one or more consecutive days and / or the individual is not admitted to the hospital for one or more days, optionally, unless or until the individual has prolonged fever or fever that is or has not been reduced or not reduced for more than 1 ºC after treatment with antipyretic.
[001041] [001041] 244.0 article of manufacture of modality 243, in which if the individual exhibits prolonged fever or reduced or not reduced or not reduced fever by more than 1 ºC after treatment with antipyretic, the instructions specify even more than the individual should be admitted to the hospital or overnight in a hospital and / or an agent or treatment should be administered for the treatment or prevention or reduction or mitigation of a neurotoxicity and / or cytokine release syndrome or risk thereof.
[001042] [001042] 245. The article of manufacture of any of the modalities 221-244, in which the instructions further specify cell therapy is for parenteral administration, optionally intravenous administration.
[001043] [001043] 246. The article of manufacture of any of the modalities 221-245, wherein the cell therapy comprises primary T cells obtained from an individual.
[001044] [001044] 247. The article of manufacture of any of the modalities 221-246, in which the T cells are autologous to the individual.
[001045] [001045] 248. The article of manufacture of any of the modalities 221-246, in which the T cells are allogeneic to the individual.
[001046] [001046] 249. The article of manufacture of any one of embodiments 221-248, wherein the article of manufacture comprises one of a plurality of cell therapy compositions comprising a first composition of genetically modified cells comprising CD4 * T cells or cells CD8 * T, where the instructions specify that the first composition is for use with a second composition comprising the other CD4 * T cell or CD8 * T cell, optionally in which the cells of the first composition and the cells of the same composition are from the same individual.
[001047] [001047] 250. The article of manufacture of modality 249, in which the instructions specify the first composition and the second composition must be administered to a defined ratio of CD4 * cells that express the recombinant receptor to CD8 * cells that express the recombinant receptor and / or from CD4 * cells to CD8 * cells, which optionally, the ratio is approximately 1: 1 or is between approximately 1: 3 and approximately 3: 1.
[001048] [001048] 251. The article of manufacture of modality 250, in which the defined ratio is or is approximately 1: 1.
[001049] [001049] 252. The article of manufacture of any of the modalities 221-251, wherein the composition further comprises a cryoprotectant and / or the article further includes instructions for defrosting the composition before administration to the individual.
[001050] [001050] 253. The article of manufacture of any of the modalities 249-252, in which the instructions specify the administration of the composition comprising the TCD4 * cells and the composition comprising the CD8 * T cells with O at 12 hours apart, 0 to 6 hours apart or 0 to 2 hours apart.
[001051] [001051] 254. The article of manufacture of any of the modalities 249-253, in which the instructions specify the administration of the composition comprising the TCD4 * cells and the composition comprising the CD8 * T cells not more than 2 hours, no more than 1 hour, no more than 30 minutes, no more than 15 minutes, no more than 10 minutes or no more than 5 minutes.
[001052] [001052] 255. The article of manufacture of any of the modalities 249-254, wherein the instructions specify the administration of the composition comprising CD4 * T cells before administering the composition comprising CD8 * cells.
[001053] [001053] 256. The article of manufacture of any of the modalities 249-254, wherein the instructions specify the administration of the composition comprising the CD8 * T cells before administering the composition comprising the CD4 * cells.
[001054] [001054] 257. Article of manufacture comprising one or more reagents capable of detecting one or more analyzed and instructions for using the reagent to test a biological sample of an individual who is a candidate for treatment, optionally with cell therapy, said therapy cell optionally comprising a dose or composition of genetically modified cells that express a recombinant receptor, in which the one or more analyzed is selected from LDH, ferritin, CRP, IL-6, IL-7, I1L-8, I1L-10, I1L -15, I1L-16, TNF-alpha, IFN-gamma, MCP-1, MIP-1beta, eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, IP-10, perforin and D-dimer (degradation product of fibrin).
[001055] [001055] 258. The article of manufacture of modality 257, further comprising cell therapy and / or further comprising instructions for use with, before and / or in connection with treatment with cell therapy.
[001056] [001056] 259. The article of manufacture of modality 257 or modality 258, further comprising one or more agents or treatments for the treatment, prevention, delay, reduction or mitigation of the development or risk of developing a toxicity and / or instructions for the administration of one or more agents or treatments for treatment, prevention, delay, reduction or mitigation of the development or risk of developing a toxicity in the individual.
[001057] [001057] 260. The article of manufacture of any of the modalities 257-259, in which the instructions further specify, if the level, quantity or concentration of the analyzed in the sample is equal to or higher than a threshold level for the analyzed: administer to the an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing toxicity (i) before, (ii) within one, two or three days after, (ill) concomitantly with and / or (iv) in the first fever after the beginning of the administration of cell therapy to the individual; and / or administering cell therapy to the individual at a reduced dose or at a dose that is not associated with the risk of developing serious toxicity or toxicity or is not associated with the risk of developing severe toxicity or toxicity in most individuals and / or the majority of individuals with a disease or condition that the individual has or is suspected to have after administration of cell therapy; and / or administering cell therapy to the individual in a hospital setting and / or with admission to the hospital for one or more days, optionally in which cell therapy should be administered to individuals on an outpatient basis or without admission to the hospital for one or more days.
[001058] [001058] 261. The article of manufacture of any of the modalities 257-259, in which the instructions further specify, whether the level, quantity or concentration of the analyzed is below a threshold level for the analyzed, administering to the individual cell therapy , optionally in a non-reduced dose, optionally on an outpatient basis or without admission to the hospital for one or more days.
[001059] [001059] 262. The article of manufacture of any of the modalities 257-261, in which the instructions further specify the administration of cell therapy to the individual and in which the instructions further specify, whether the level, quantity or concentration of the analyzed and, is below a threshold level: the administration of cell therapy does not include the administration, before or concurrently with the administration of cell therapy and / or before the development of a symptom sign of toxicity other than fever, an agent or treatment capable of treat, prevent, delay or mitigate the development of toxicity; and / or the administration of cell therapy should be or can be administered to the patient on an outpatient basis and / or without admission of the patient to the hospital overnight or for one or more consecutive days and / or without admission of the patient to the hospital hospital for one or more days.
[001060] [001060] 263. The article of manufacture of any of the modalities 257-262, in which the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% of the level mean, quantity or concentration and / or is within a standard deviation from the mean level, quantity or concentration, of that analyzed in a biological sample obtained from a group of individuals before receiving a therapeutic cell composition that expresses the recombinant receptor, in which each one of the individuals in the group started to develop toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[001061] [001061] 264. Article of manufacture comprising: a cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells expressing a recombinant receptor, and instructions for administering the cell therapy after or based on the results of an evaluation , in a biological sample of the level, or quantity or concentration of one or more analyzed in a biological sample, said biological sample being obtained from the individual prior to the administration of the therapy cell and / or said biological sample that does not include the recombinant receptor and / or said modified cells, in which the one or more analyzed is selected from LDH, ferritin, CRP, IL-6, IL-7, IL-8, I1L-10, I1L-15, IL-16, TNF-alpha , IFN-gamma, MCP-1, MIP-1beta, eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, IP-10, perforin and D-dimer (fibrin degradation product).
[001062] [001062] 265. The article of manufacture of modality 264, in which said assessment comprises detection that optionally comprises the contact of a reagent capable of directly or indirectly detecting the analyzed with the biological sample and determining the level, quantity or concentration of the analyzed in the biological sample.
[001063] [001063] 266. The article of manufacture of modality 265, further comprising the reagent and / or further comprising instructions for use with, before and / or in connection with the reagent to detect the analyzed.
[001064] [001064] 267. The article of manufacture of any of the modalities 264-266, further comprising one or more agents or treatments for treatment, prevention, delay, reduction or mitigation of the development or risk of developing a toxicity and / or instructions for the administration of one or more agents or treatments for treatment, prevention, delay, reduction or mitigation of the development or risk of developing a toxicity in the individual.
[001065] [001065] 268. The article of manufacture of any of the modalities 264-267, in which the instructions to administer the cell therapy specify, if the level, quantity or concentration of the analyzed in the sample is equal or superior to a threshold level: administer to the individual an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity (i) before, (ii) within one, two or three days after, (iii) concomitantly with and / or (iv) in the first fever after the administration of the administration of the therapeutic cell composition or of the genetically modified cells begins; and / or administering cell therapy to the individual at a reduced dose or at a dose that is not associated with the risk of developing serious toxicity or toxicity or is not associated with the risk of developing severe toxicity or toxicity in most individuals and / or the majority of individuals with a disease or condition that the individual has or is suspected to have after administration of cell therapy; and / or administering cell therapy to the individual in a hospital setting and / or with admission to the hospital for one or more days, optionally in which cell therapy should be administered to individuals on an outpatient basis or without admission to the hospital for one or more days.
[001066] [001066] 269. The article of manufacture of any of the modalities 264-268, in which the instructions to administer the cell therapy specify, if the level, quantity or concentration of the analyzed in the sample is below a threshold level, administering to the individual the therapy cell, optionally in a non-reduced dose, optionally on an outpatient basis or without admission to the hospital for one or more days.
[001067] [001067] 270. The article of manufacture of any of the modalities 264-269, in which the instructions further specify the administration of cell therapy for the individual and in which the instructions further specify, whether the level, quantity or concentration of the analyzed is below a threshold level: do not administer, before or simultaneously with the administration of cell therapy and / or before the development of a sign or symptom of a toxicity other than fever, an agent or treatment capable of treating, preventing, delaying or mitigating the development of toxicity; and / or the administration of cell therapy must be or can be administered to the patient on an outpatient basis and / or without admission of the patient to the hospital overnight or for one or more consecutive days and / or without admission of the patient to the hospital for one or more more days.
[001068] [001068] 271. The article of manufacture of any of the modalities 264-270, in which the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% of the level , mean quantity or concentration and / or is within a standard deviation from the mean level, quantity or concentration, of that analyzed in a biological sample obtained from a group of individuals before receiving a therapeutic cell composition that expresses the recombinant receptor, in which each one of the individuals in the group started to develop toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[001069] [001069] 272. Article of manufacture comprising an agent capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity and instructions for administering the agent after or based on the results of an evaluation on a sample level, quantity or concentration of one or more analyzed in a biological sample, in which the one or more analyzed is selected from LDH, ferritin, CRP, IL-6, IL-7, IL-8, I1L-10 , IL-15, IL-16, TNF-alpha, IFN-gamma, MCP-1, MIP-1beta, eotaxin, G-CSF, IL-1Ralfa, IL-1Rbeta, IP-10, perforin and D-dimer (product of fibrin degradation).
[001070] [001070] 273. The article of manufacture of modality 272, in which said assessment comprises detection that optionally comprises the contact of a reagent capable of directly or indirectly detecting the analyzed with the biological sample and determining the level, quantity or concentration of the analyzed in the biological sample.
[001071] [001071] 274. The article of manufacture of modality 272 or modality 273, in which the instructions specify that the agent should be administered i) before, (ii) within one, two or three days after, (iii) simultaneously with and / or (iv) in the first fever after, the beginning of the administration of cell therapy to the individual and / or still comprises instructions for use before, and / or in connection with the treatment with cell therapy.
[001072] [001072] 275. The article of manufacture of any of the modalities 272-274, in which said biological sample is obtained from the individual before the administration of the agent or cell therapy.
[001073] [001073] 276. The article of manufacture of any of the modalities 257-275, in which the reagent is a binding molecule that binds specifically to the analyzed.
[001074] [001074] 277. The article of manufacture of any of the modalities 257-276, in which the reagent is an antibody or an antigen-binding fragment thereof.
[001075] [001075] 278. The article of manufacture of any of the modalities 257-277, in which the biological sample is or is obtained from a blood, plasma or serum sample.
[001076] [001076] 279. The article of manufacture of any of the modalities 272-278, further comprising the reagent to detect the analyzed and / or further comprising instructions for use with, before and / or in connection with the reagent to detect the analyzed.
[001077] [001077] 280. The article of manufacture of any of the modalities 272-279, further comprising cell therapy and / or further comprising instructions for use with, before and / or in connection with treatment with cell therapy.
[001078] [001078] 281. The article of manufacture of any of the modalities 272-280, in which the instructions for administering the agent specify, if the level, quantity or concentration of the analyzed in the sample is equal to or above a threshold level, administering to the individual the agent.
[001079] [001079] 282. The article of manufacture of modality 281, in which the instructions further specify the administration of a cell therapy to the individual, in which the administration of the agent must be performed (i) before, (ii) within one, two or three days of (iii) concomitantly with and / or (iv) in the first fever after the start of administration of cell therapy to the individual.
[001080] [001080] 283. The article of manufacture of any of the modalities 272-282, in which the instructions for administering the agent specify, if the level, quantity or concentration is below the threshold level that optionally administers the cell therapy. Where the instructions specify the cell, therapy should be or can be administered to the patient on an outpatient basis and / or without the patient's admission to the hospital overnight or for one or more consecutive days and / or without the patient's admission to the hospital for one or more days.
[001081] [001081] 284. The article of manufacture of any of the modalities 272-283, in which the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% of the level , mean quantity or concentration and / or is within a standard deviation from the mean level, quantity or concentration, of that analyzed in a biological sample obtained from a group of individuals before receiving a therapeutic cell composition that expresses the recombinant receptor, in which each one of the individuals in the group started to develop toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[001082] [001082] 285. The article of manufacture of any of the modalities 257-284, in which the analysis or evaluation of cells for the analyzed is performed by an immunoassay.
[001083] [001083] 286. The article of manufacture of any of the modalities —257-285, in which the toxicity comprises neurotoxicity or cytokine release syndrome (SLC), optionally neurotoxicity or SLC grade 1 or higher.
[001084] [001084] 287. The article of manufacture of any of the modalities 257-286, in which: the toxicity comprises severe neurotoxicity and / or comprises a neurotoxicity grade 2 or higher, a neurotoxicity grade 3 or higher, at least one neurotoxicity grade 3 prolonged or is equal to or greater than grade 4 or 5 neurotoxicity; and / or the toxicity comprises severe SLC and / or comprises SLC grade 2 or higher or SLC grade 3 or higher.
[001085] [001085] 288. The article of manufacture of any of the modalities 257-287, in which toxicity is associated with cerebral edema.
[001086] [001086] 289. The article of manufacture of any of the modalities 257-288, wherein the agent or other treatment is or comprises one or more of a steroid; a cytokine or cytokine receptor antagonist or inhibitor selected from IL-10, IL-10R, IL-6, IL-6 receptor, IFNy, IFNGR, IL-2, IL-2R / CD25, MCP-1, CCR 2, CCRA4, MIP1B, CCR5, TNFalpha, TNFRI1, IL-1 and IL-1IRalfa / IL-1beta; or an agent capable of preventing, blocking or reducing the activity or function of microglial cells.
[001087] [001087] 290. The article of manufacture of modality 289, in which the antagonist or inhibitor is or comprises an agent selected from an antibody or antigen-binding fragment, a small molecule, a protein or peptide and a nucleic acid.
[001088] [001088] 291. The article of manufacture of any of embodiments 257-290, wherein the agent or other treatment is an anti-IL-6 antibody or an anti-IL6 receptor antibody.
[001089] [001089] 292. The article of manufacture of any of the modalities 257-291, in which the agent or other treatment is or comprises an agent selected from tocilizumab, siltuximab, clazakizumab, sarilumab, olokizumab (CDP6038), elsilimomabe, ALD518 / BMS -945429, sirukumab (CNTO 136), CPSI-2634, ARGX-109, FE301 and FM101.
[001090] [001090] 293. The article of manufacture of any of the modalities 257-292, in which the agent or other treatment is or comprises tocilizumab.
[001091] [001091] 294. The article of manufacture of any of the modalities 257-293, in which the agent or other treatment is or comprises siltuximab.
[001092] [001092] 295. The article of manufacture of modality 289, in which the steroid is or comprises dexamethasone.
[001093] [001093] 296. The article of manufacture of modality 289, in which the agent capable of preventing, blocking or reducing the activity or function of microglial cells is selected from an anti-inflammatory agent, a NADPH oxidase (NOX2) inhibitor , a calcium channel blocker, a sodium channel blocker, inhibits GM-CSF, inhibits CSFIR, specifically binds to CSF-1, specifically binds to IL-34, inhibits the activation of nuclear factor cover B (NF- KB), activates a CB2 receptor and / or is a CB2 agonist, a phosphodiesterase inhibitor, inhibits microRNA-155 (miR-155) or up-regulates microRNA-124 (miR-124).
[001094] [001094] 297. The article of manufacture of modality 296, in which the agent capable of preventing, blocking or reducing the activation or function of microglialis cells is a small molecule, peptide, protein, antibody or antigen-binding fragment, an antibody mimetic, an aptamer or a nucleic acid molecule.
[001095] [001095] 298. The article of manufacture of modality 296 or modality 297, in which the agent is selected from minocycline, naloxone, —nimodipine, Riluzole, MORI103, lenalidomiday a cannabinoid, optionally WIN55 or 212-2, intravenous immunoglobulin (IVlg) , ibudilast, anti-miR-155 blocked nucleic acid (LNA), MCS110, PLX-3297, PLX647, PLX108-D1, PLX7486, JNJ- 40346527, JNJ28312141, ARRY-382, AC-708, DCC-3014, 5- ( 3- methoxy-4 - (((4-methoxybenzyl) Oxy) benzyl) pyrimidine-2,4-diamine (GW2580), AZD6495, Ki20227, BLZ945, emactuzumab, IMC-CSA4, FPAOO8, LY-3022855, AMG-820 and TG -3003.
[001096] [001096] 299. The article of manufacture of any of the modalities 296-298, in which the agent is an inhibitor of the colony stimulating factor 1 receptor (CSF1IR).
[001097] [001097] 300. The article of manufacture of any of the modalities 296-299, in which the inhibitor is selected from: PLX-3397, PLX647, PLX108-D1, PLX7486, JNJ-40346527, JNJ28312141, ARRY-382, AC- 708, DCC-3014, 5- (3-methoxy-4 - ((4-methoxybenzyl) oxy) benzyl) pyrimidine -2,4-diamine (GW2580), AZD6495, Ki20227, BLZ945 or a pharmaceutical or prodrug salt thereof;
[001098] [001098] 301. The article of manufacture of any of the modalities 296-300, in which the inhibitor is PLX-3397.
[001099] [001099] 302. The article of manufacture of any of the modalities 24-48 and 257-301, in which the recombinant receptor specifically binds to an antigen associated with the disease or condition or expressed in the cells of the environment of an injury associated with the disease or condition.
[001100] [001100] 303. The article of manufacture of any of the modalities 24-48 and 257-302, in which the disease or condition is a cancer.
[001101] [001101] 304. The article of manufacture of any of the modalities 24-48 and 257-303, in which the disease or condition is a myeloma, leukemia or lymphoma.
[001102] [001102] 305. The article of manufacture of any of the modalities 24-48 and 257-304, in which the disease or condition is a neoplasm of B cells and / or is acute lymphoblastic leukemia (ALL), ALL adult, leukemia chronic lymphoblastic (LLC), non-Hodgkin's lymphoma (NHL) and diffuse large B cell lymphoma (LDGCB).
[001103] [001103] 306. The article of manufacture of any of the modalities 302-305, in which the antigen is ROR1, B cell maturation antigen (AMCB), carbonic anhydrase 9 (CAIX), tEGFR, Her2 / neu (tyrosine receptor erbB2 kinase), LI-CAM, CD19, CD20, CD22, mesothelin, CEA and hepatitis B surface antigen, antifolate receptor, CD23, CD24, CD30, CD33, CD38, CD44, EGFR, epithelial glycoprotein 2 (GEP-2) , epithelial glycoprotein 40 (EPG-40), EPHa2, erb-B2, erb-B3, erb-B4, erbB, EGFR vill, folate-binding protein (FBP), FCRL5, FOCRHS5, fetal acetylcholine receptor,
[001104] [001104] 307. The article of manufacture of any of the modalities 24-48 and 257-306, wherein the recombinant receptor is a T cell receptor or a functional non-T cell receptor.
[001105] [001105] 308. The article of manufacture of any of the modalities 24-48 and 257-307, in which the recombinant receptor is a chimeric antigen (RAQ) receptor.
[001106] [001106] 309. The article of manufacture of modality 308, in which the RAQ comprises an extracellular antigen recognition domain that binds specifically to the antigen and an intracellular signaling domain comprising an ITAM, in which optionally, the signaling domain intracellular comprises an intracellular domain of a CD3-zeta chain (CD3); and / or where the RAQ further comprises a co-stimulating signaling region,
[001107] [001107] 310. The article of manufacture of any of the modalities 24-48 and 257-309, in which the modified cells comprise T cells, optionally CD4 * and / or CD8 *.
[001108] [001108] 311. The article of manufacture of modality 310, in which T cells are primary T cells obtained from an individual.
[001109] [001109] 312. The article of manufacture of any of the modalities 257-311, in which the dose that is not associated with the risk of developing serious toxicity or toxicity is or comprises less than or less than about 5 x 107 expression cells of total recombinant receptors, optionally RAQ * cells, total T cells or total peripheral blood mononuclear cells (PBMCs), as less than or less than about 2.5 x 107, less than or less than about 1.0 x 107 , less than or less than 5.0 x 10º, less than or less than 1.0 x 10º, less or less than about 5.0 x 10º or less than or equal to about 1 x 10º receptor expression cells total recombinant, optionally - RAQ cells ”, total T cells or total peripheral blood mononuclear cells (PBMC).
[001110] [001110] 313. The article of manufacture of any of the modalities 257-312, in which the dose that is not associated with the risk of developing toxicity or severe toxicity is or comprises of or from about 1 x 10 to 5 x 107 cells of expression of total recombinant receptors, optionally RAQ cells ”, total T cells or total peripheral blood mononuclear cells (PBMC), such as 1 x 10º to 2.5 x 107, 1 x 10º to 1.0 x 107, 1x 10º to 5.0 x 108, 1 x 10º to 1.0 x 106, 1.0 x 10º to 5.0 x 105, 5.0 x 10º to 5x 107, 5x 10º to 2.5 x 107, 5x 10º a 1.0 x 107, 5x 10º to 5.0 x 106, 5x 10º to 1.0 x 106, 1.0 x 10º to 5x 107, 1x 10º to 2.5x 107, 1 x 10º to 1.0 x 107 , 1 x 10 to 5.0 x 108, 5.0 x
[001111] [001111] 314. The article of manufacture of any of the modalities 257-313, in which the reagent is marked in a detectable way, optionally marked by fluorescence.
[001112] [001112] 315. The article of manufacture of any of the modalities 257-314, in which the one or more analyzed is LDH, ferritin, CRP, IL-6, IL-8, 11-10, TNF-alpha, IFN- alpha2, MCP-1 and MCP-1beta.
[001113] [001113] 316. The article of manufacture of any of the modalities 257-315, in which the one or more analyzed is or comprises LDH.
[001114] [001114] 317. The article of manufacture of any of the modalities 221-316, in which: the RAQ comprises a scFv specific for the antigen, a transmembrane domain, a cytoplasmic signaling domain derived from a costimulatory molecule, which is optionally or comprises a 4-1BB, and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which optionally is or comprises a CD3zeta signaling domain and optionally further comprises a spacer between the transmembrane domain and the scFv; the RAQ comprises, in order, an antigen-specific scFv, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulatory molecule, which optionally is or comprises a 4-1BB signaling domain and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which optionally is a CD3zeta signaling domain; or the RAQ comprises, in order, an antigen-specific scFv, a spacer, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulating molecule, which optionally is a 4-1BB signaling domain and a cytoplasmic signaling domain a primary signaling molecule containing ITAM, which optionally is or comprises a CD3zeta signaling domain; and where:
[001115] [001115] 318. Article of manufacture, according to any one of claims 221-317, in which the instructions provide information on a threshold level, individually for each one or more analyzed, which is indicative of the probability of an individual displaying a response to treatment with cell therapy.
[001116] [001116] 319. Article of manufacture according to any one of claims 221-317, in which the instructions provide information on a threshold level, individually for each of the one or more analyzed, which is indicative that an individual is likely will exhibit a durable response after administration of cell therapy.
[001117] [001117] 320. Article of manufacture, according to any one of claims 221-317, in which the instructions provide information on a threshold level, individually for each one or more analyzed, which is indicative of the probability of an individual displaying toxicity after administration of cell therapy. VIII. DEFINITIONS
[001118] [001118] The terms "polypeptide" and "protein" are used interchangeably to refer to a polymer of amino acid residues, and are not limited to a minimum length. Polypeptides, including the receptors provided and other polypeptides, for example, linkers or peptides, can include amino acid residues, including natural and / or unnatural amino acid residues. The terms also include post-expression modifications of the polypeptide, for example, glycosylation, sialylation, acetylation and phosphorylation. In some respects, polypeptides may contain modifications in relation to a native or natural sequence, as long as the protein maintains the desired activity. These changes can be deliberate, such as by means of site-directed mutagenesis, or they can be accidental, such as by means of host mutations that produce proteins or errors due to PCR amplification.
[001119] [001119] When used here, an "individual" is a mammal, like a human or other animal, and is usually human. In some embodiments, the individual, for example, the patient, to whom the agent or agents, cells, populations of cells or compositions are administered, is a mammal, typically a primate, like a human. In some modalities, the primate is either a monkey or an ape. The individual can be male or female and can be of any suitable age, including infant, juvenile, adolescent, adult and geriatric individuals. In some embodiments, the individual is a non-primate mammal, like a rodent.
[001120] [001120] When used herein, "treatment" (and grammatical variations thereof, such as "treating" or "treatment") refers to the improvement or complete or partial reduction of a disease or condition or disorder, or a symptom, adverse effect or result, or phenotype associated with it. Desirable effects of treatment include, but are not limited to, preventing the occurrence or recurrence of the disease, relieving symptoms, decreasing any direct or indirect pathological consequences of the disease, preventing metastasis, decreasing the rate of disease progression, improving or palliating the condition disease and improved remission or prognosis. The terms do not imply the complete cure of an illness or the complete elimination of any symptom or effect (s) in all symptoms or results.
[001121] [001121] When used here, "delaying the development of a disease" means postponing, hindering, delaying, delaying, stabilizing, suppressing and / or postponing the development of the disease (such as cancer). This delay can be of variable duration, depending on the history of the disease and / or the individual to be treated. In some modalities, sufficient or significant delay may, in effect, encompass prevention, insofar as the individual does not develop the disease. For example, cancer at an advanced stage, such as the development of metastases, can be delayed.
[001122] [001122] "Prevention", when used here, includes providing prophylaxis with respect to the occurrence or recurrence of a disease in an individual who may be predisposed to the disease, but has not yet been diagnosed with the disease. In some embodiments, the cells and compositions provided are used to slow the development of a disease or to slow the progression of a disease.
[001123] [001123] When used here, "suppressing" a function or activity is to reduce the function or activity when compared to the same conditions, except for one condition or parameter of interest, or alternatively, compared to another condition. For example, cells that suppress tumor growth reduce the rate of tumor growth compared to the rate of tumor growth in the absence of cells.
[001124] [001124] An "effective amount" of an agent, for example, a formulation, cells or pharmaceutical composition, in the context of administration, - refers to an effective amount in dosages / quantities and for periods of time necessary to achieve the desired result , as a therapeutic or prophylactic result.
[001125] [001125] A "therapeutically effective amount" of an agent, for example, a pharmaceutical formulation or cells, refers to an effective amount, in dosages and for periods of time necessary, to achieve a desired therapeutic result, such as for treatment of a disease, condition or disorder and / or pharmacokinetic or pharmacodynamic effect of treatment. The therapeutically effective amount may vary according to factors such as the condition of the disease, age, sex and weight of the individual and the populations of cells administered. In some embodiments, the methods provided involve administering cells and / or compositions in effective amounts, for example, therapeutically effective amounts.
[001126] [001126] A "prophylactically effective amount" refers to an effective amount, in dosages and for necessary periods of time,
[001127] [001127] The term "about", when used here, refers to the usual error range for the respective value easily known by the person skilled in this technical field. The reference to "about" a value or parameter in this document includes (and describes) modalities that target that value or parameter per se.
[001128] [001128] When used here, the singular forms "one", "one" and "o (a)" include plural referents, unless the context clearly indicates otherwise. For example, "one" or "one" means "at least one" or "one or more".
[001129] [001129] Throughout this description, various aspects of the claimed individual are presented in an interval format. It should be understood that the description in the interval format is merely for convenience and brevity and should not be interpreted as an inflexible limitation on the scope of the claimed object. Therefore, the description of an interval should be considered as having specifically disclosed all possible subintervals, as well as individual numerical values within that interval. For example, when a range of values is provided, it is understood that each intermediate value, between the upper and lower limit of that range and any other declared or intervening value in that declared range, is covered by the claimed object. The upper and lower limits of these smaller ranges can be included independently in the smaller ranges and are also included in the claimed object, individuals at any limit specifically excluded in the indicated range. When the stated range includes one or both of the limits, ranges excluding one or both of the included limits are also included in the claimed individual. This applies regardless of the span of the range.
[001130] [001130] When used herein, a composition refers to any mixture of two or more products, substances or compounds, including cells. It can be a solution, a suspension, liquid, powder, a paste, aqueous, non-aqueous or any combination thereof.
[001131] [001131] When used here, "enrich" when referring to one or more cell types or populations of cells in particular, refers to increasing the number or percentage of the cell type or population, for example, compared to the total number of cells or volume of the composition, or in relation to other types of cells, such as by positive selection based on markers expressed by the population or cell, or by negative selection based on a marker not present in the population of cells or cell to be depleted . The term does not require complete removal of other cells, cell type or populations from the composition and does not require that the cells so enriched are present in or even close to 100% in the enriched composition.
[001132] [001132] When used here, a statement that a cell or population of cells is "positive" for a specific marker refers to the detectable presence in the cell or within a specific marker, typically a surface marker. When referring to a surface marker, the term refers to the presence of surface expression as detected by flow cytometry, for example, by staining with an antibody that specifically binds to the marker and by detecting said antibody, where staining is detectable by flow cytometry at a level substantially above the detected staining by performing the same procedure with an isotype-matched control or fluorescence obstruction minus one (FMO) control under identical conditions and / or at a level substantially similar to that of cell known to be positive for the marker, and / or at a level substantially higher than that of a cell known to be negative for the marker.
[001133] [001133] When used herein, a statement that a cell or population of cells is "negative" for a specific marker refers to the absence of substantial detectable presence in or on the cell of a specific marker, typically a surface marker. When referring to a surface marker, the term refers to the absence of surface expression as detected by flow cytometry, for example, by staining with an antibody that specifically binds to the marker and by detecting said antibody, where staining is not detected by flow cytometry at a level substantially above the detected staining by performing the same procedure with an isotype-matched control or fluorescence obstruction minus one (FMO) under identical conditions, and / or at a substantially lower level that of the cell known to be positive for the marker and / or at a substantially similar level compared to that of a cell known to be negative for the marker.
[001134] [001134] The term "vector", when used here, refers to a nucleic acid molecule capable of propagating another nucleic acid to which it is attached. The term includes the vector as a self-replicating nucleic acid structure, as well as the vector incorporated into the genome of a host cell into which it has been introduced. Certain vectors are capable of directing the expression of nucleic acids to which they are operationally linked. Such vectors are referred to here as
[001135] [001135] Unless otherwise defined, all terms of the technique, notations and other technical or scientific terms or terminology used herein have the same meaning as is commonly understood to which the claimed individual belongs. In some cases, terms with commonly understood meanings are defined here for clarity and / or immediate reference, and the inclusion of such definitions here should not necessarily be construed to represent a substantial difference from what is generally understood.
[001136] [001136] All publications, including patent documents, scientific articles and databases, mentioned in this application are incorporated by reference in their entirety for all purposes, to the same extent as if each individual publication were incorporated individually by reference. If a definition set out in this document is contrary to or inconsistent with a definition set out in patents, orders, published orders and other publications which are incorporated herein by reference, the definition set forth herein takes precedence over the definition which is incorporated here by reference.
[001137] [001137] The section titles used here are for organizational purposes only and should not be interpreted as limiting the individual described. IX. EXAMPLES
[001138] [001138] The following examples are included for illustrative purposes only and are not intended to limit the scope of the invention. Example 1: Administration of Anti-CD19 RAQ Expression Cells to Individuals with Recurrent and Refractory Non-Hodgkin's Lymphoma A. Individuals and Treatment
[001139] [001139] Therapeutic RAQ * T cell compositions containing autologous T cells expressing a CD19 specific chimeric antigen (RAQ) receptor have been administered to individuals with B cell malignancies. Example 1.A.1
[001140] [001140] The results are described in this Example 1.A.1 for evaluation over a certain period of time (1.A.1) in an ongoing clinical study that administers this therapy in patients with B cell malignancies. Specifically, a cohort (complete cohort) of (at this time, fifty-five (55)) adult human individuals with relapsed or refractory aggressive non-Hodgkin's (NHL) lymphoma, including diffuse large B-cell lymphoma (LDGCB), de novo or transformed from indolent lymphoma (NOS), high-grade B-cell lymphoma, with MYC and BCL2 rearrangements and / or BCL6 with histology of LDGCB (double / triple hit), LDGCB transformed from chronic lymphocytic leukemia ( LLC) or marginal zone lymphomas (LZM), primary mediastinal large cell lymphoma (LCBMP) and grade 3b follicular lymphoma (LF3B) after failure of 2 lines of therapy. Among the individuals treated were those with scores from the Eastern Oncology Cooperative Group (ECOG) between 0 and 2 (mean follow-up of 3.2 months). The complete cohort did not include individuals with lining cell lymphoma (CSF). No individual was excluded based on previous allogeneic stem cell transplantation (SCT), central nervous system (CNS) involvement or ECOG score of 2, and there was no minimum absolute lymphocyte count (CLA) for apheresis.
[001141] [001141] Results were assessed separately for a major subset of individuals within the full cohort (individuals within the full cohort, excluding those with poor performance status (ECOG 2), LDGCB transformed from marginal zone lymphomas (LZM) and / or chronic lymphocytic leukemia
[001142] [001142] The demographic and baseline characteristics of individuals in the full and main cohort at the time point in Example 1.A.1 are shown in Table E1.
[001143] [001143] Therapeutic T cell compositions administered were generated by a process that includes immunoaffinity based enrichment (e.g., immunomagnetic selection) of CD4 * and CD8 '* cells from leukapheresis samples from individual individuals to be treated. Isolated CD4 * and CD8 * T cells were activated separately and independently transduced with a viral vector (eg, lentiviral vector) encoding an anti-CD19 RAQ, followed by separate expansion and cryopreservation of the modified cell populations at a low volume. The RAQ contained an anti-CD19 scFv derived from a murine antibody (variable region derived from FMC63, VL-ligand-VH orientation), an immunoglobulin derived spacer, a transmembrane domain derived from CD28, a co-stimulatory region derived from 4-1BB , and an intracellular CD3-zeta signaling domain. The viral vector also contained sequences encoding a truncated receptor, which served as a substitute marker for RAQ expression; separated from the RAQ sequence by a jump sequence of the T2A ribosome.
[001144] [001144] Cryopreserved cell compositions were thawed prior to intravenous administration. The therapeutic dose of T cells was administered as a defined cell composition, delivering a population of formulated CD4 * RAQ * cells and a population of formulated CD8 * RAQ * cells, administered at a target ratio of approximately 1: 1. Subjects received a dose single or double RAQ expression T cells (each single dose by separate infusion of CD4 * RAQ expression T cells and CD8 RAQ expression T cells, respectively) as follows: a single dose of dose level 1 (ND-1) containing x 107 total RAQ expression T cells (n = 30 for subjects evaluated in Example 1.A.1), a double dose of ND1 in which each dose was administered with an interval of approximately fourteen (14 ) days (n = 6 for subjects evaluated in Example 1.A1, administered on day 1 and day 14, including an individual who inadvertently received two doses of ND2 via a two-dose schedule due to a dosing error) or one dose single dose level 2 (ND-2) containing 1 x 10th total RAQ expression T cells (n = 18 for individuals evaluated in Example 1.A.1). The target dose level and the number of T cell subsets for the administered compositions are shown in Table E2. cell compositions containing anti-CD19 RAQ T cells
[001145] [001145] Starting before the infusion of RAQ T cells *, subjects - received lymphodeplective chemotherapy “with fludarabine (flu, 30 mg / m ) And cyclophosphamide (Cy, 300 mg / m2) for three
[001146] [001146] For Example 1.A.2, in a subsequent moment in the clinical study described in this Example 1 above, the results were analyzed. At this point of analysis in Example 1.A.2, 74 patients were treated (51 men, 23 women). Subjects included sixty-nine (69) individuals from the complete LDGCB cohort (including 67 LDGCB NOS (45 again, 14 transformed from FL, 8 transformed from LLC or LZM), 1 LF grade 3B and 1 LCBMP) and 5 individuals from the cohort LCM. Among the individuals in the complete cohort (LDGCB), the median age was 61 years (range 26, 82), the median of previous therapies was 3 (range 1, 12), 46 (67%) were chemotherapeutic, 32 (46 %) had a transplant, and at least 16 (23%) patients had doubleftriple hit lymphoma. Forty-nine (49) individuals from the main cohort were evaluated at this time in 1.A.2. B. Security
[001147] [001147] The presence or absence of treatment-emergent adverse events (EAET) after administration of RAQ-T cell therapy was assessed. The individuals were also evaluated and monitored for neurotoxicity (neurological complications, including symptoms of confusion, aphasia, encephalopathy, myoclonic seizures, seizures, lethargy and / or altered mental status), classified on a scale of 1 to 5, according to National Cancer Institute scale - Common Toxicity Criteria (CTCAE), version 4.03 (NCI-CTCAE v4.03). Common Toxicity Criteria (CTCAE) scale, version
[001148] [001148] Example 1.B.1 describes the results based on the time point of the analysis in Example 1.A.1.
[001149] [001149] FIG. 1 shows the percentage of these individuals who observed laboratory abnormalities and EAETs, which occurred in>% of the individuals. In addition to the EAETs shown in FIG. 1, the following terms of the event were observed in Grade 3-4 in 25% of patients: decreased white blood cell count (13.6%), encephalopathy (12%), hypertension (7%). The degree of toxicity observed was consistent between dose levels 1 and 2.
[001150] [001150] In 84% of individuals in the full cohort in Example
[001151] [001151] FIG. 2 shows a Kaplan meier curve representing the time observed for the onset of SLC and / or neurotoxicity for the analysis in 1.B.1. As shown, the average times observed for the onset of SLC and the onset of neurotoxicity were 5 and 11 days, respectively, with only 11% of patients experiencing the onset of SLC less than 72 hours after the start of cell therapy administration. The mean time to resolution of the SLC and neurotoxicity to Grade 1 or better was 5 and 7 days, respectively. The average time to complete resolution of the SLC and neurotoxicity was 5 and 11 days, respectively. The results were consistent with the conclusion that there was a low rate of early onset of any SLC or neurotoxicity in the subjects. Example 1.B.2
[001152] [001152] Example 1.B.2 describes the assessment at the time of example 1.B.2. Up to this point, adverse event (AE) data has been collected from lymphodepletion (LD) up to 90 days after administration of RAQ expression T cells. In the second moment, 69 individuals from the LDGCB cohort (complete cohort) were evaluated for safety, 38 who received ND1 in a single dose, in ND2 in a single dose and 6 in ND1 in a double dose. The most common EAETs, in addition to SLC or NT, included neutropenia (41%, 28/69), fatigue (30%, 21/69), thrombocytopenia (30%, 21/69) and anemia (26%, 18/69 ). A Grade 5 EAET of diffuse alveolar damage was observed.
[001153] [001153] No acute infusional toxicity was observed and the majority of the individuals in the complete cohort, 64% (44/69), did not have SLC or NT, indicating that ambulatory release of RAQ T cells may be possible. The toxicity rates associated with RAQ T cells, including SLC and NT, did not differ between dose levels. It was observed that the safety profile was similar between cohorts and dose levels. Among the 25 individuals in the complete cohort (36%) who had some degree or SLC degree, 21 (30%) had SLC and 14 (20%) had NT. No individual had Grade 3 SLC and only one (1%, 1/69) had Grade 4 SLC and required ICU care; the other 29% (20/69) had SLC grade 1 - 2. Of the 20% of individuals with NT, 6% (4/69) had Grade 1 - 2 and 14% (10/69) had Grade 3-4; 2 (3%) had seizures. Grade 5 SLC or grade 5 NT was not observed. No incidence of cerebral edema was observed. All SLC and NT events were resolved, except for a Grade 1 tremor case, which was in progress at the time of the analysis. The average time to start the first SLC and NT was 5 days (range 2, 12) and 10 days (range 5, 23), respectively. In the first 72 hours after the infusion, no individual with NT was observed and only 10% (7/69) were observed with SLC (all grades 1); NT was preceded by SLC in> 70% of the individuals. Overall, thirteen (13) individuals (19%) required intervention for SLC or NT with anticytokine therapy (tocilizumab alone 1 (1%), dexamethasone alone 6 (9%) or both 6 (9%)) and only one needed any vasopressor support. The median doses of tociizumab and dexamethasone were 1 and 6, respectively. The median duration of SLC and NT was 5 and 11 days, respectively. The analysis of the main cohort (n = 49) also showed similar rates of SLC and NT.
[001154] [001154] In this evaluation, low incidences and late onset of SLC and / or NT were observed at both dose levels, supporting the viability of outpatient infusion, as in hospital admission at the first sign of fever or fever that lasts longer than one certain period of time. No Grade 5 SLC or Grade 5 NT was observed, and all severe SLC and severe NT were resolved. In addition, approximately 2 out of 3 patients did not have SLC or NT, supporting that the cells can be administered on an outpatient basis. At the time of assessment in 1.B.2, four individuals had been treated at the outpatient clinic. In addition, no significant differences in toxicity were observed in individuals who received ND1 or ND 2, indicating that higher response rates were obtained without an increased risk of toxicity or safety concerns. C. Response Results After Treatment
[001155] [001155] Individuals were monitored for response, including assessing tumor burden at 1, 3, 6, 7, 12, 18 and 24 months after administration of RAQ T cells *. Example 1.C.1
[001156] [001156] Example 1.C.1 describes the results based on the time point of the analysis in examples 1.A.1 and 1.B.1.
[001157] [001157] Response rates are listed in Table E4. High durable response rates were observed in the cohort of individuals, which included heavily pretreated individuals or those with poor prognosis and / or with relapsing or refractory disease. For individuals of all doses in the Main cohort (n = 44), the observed global response rate (TRG) was 86% and the observed complete response rate (CR) was 59%. At three months of the main cohort, the overall response rate (TRG) was 66%; the three-month CR rate was 50% among the main cohort. In the main cohort, the three-month GTR was 58% (11/19) at dose level 1 and 78% at dose level 2; the 3-month CRrate was 42% (8/19) for dose level 1 and 56% (5/9) for dose level 2, consistent with a suggested dose-response effect on treatment outcome. In addition, the results were consistent with a relationship between dose and response durability. And Everyone Everyone
[001158] [001158] The overall response rates between various subgroups of individuals in the full and central cohorts are shown in FIG. 3A and 3B, respectively. In the low-risk LDGCB subgroups, response rates were generally high. A GTR greater than 50% was observed in 3 months in patients with molecular subtype double / triple hitli who had refractory LDGCB or primary chemoreceptor or who had never achieved CR before. Complete resolution of CNS involvement by lymphoma was seen in 2 patients.
[001159] [001159] Among the subjects treated six months or more before the specific moment of the evaluation, of the ten (10) patients who responded in three months, 9 (90%) remained in response in six months. At the time of the assessment, 97% of the individuals in the main subset who responded were alive and, at follow-up, mean follow-up time of 3.2 months.
[001160] [001160] Results for response duration and overall survival (grouped by best overall response (non-responder,
[001161] [001161] FIG.8 shows a graph representing progression-free time (months) for individual individuals in the full and main cohorts. Each bar represents a single patient. Shading indicates the best overall response (in each case, unless otherwise stated, achieved in 1 month); texture indicates dose (solid = dose level 1, single dose; hatch, dose level 2, single dose; vertical hatch = dose level 1, two doses). The horizontal arrows indicate a continuous response. Certain individual subjects were initially assessed (for example, at 1 month) as exhibiting stable disease (ED) or partial response (PR), and later it was observed that they achieved a PR (eg conversion from DE to PR) or CR . In these cases, the shading of the patient's individual bar, as noted, indicates the best overall response and the dots (same shading correspondence to the response achieved) along each individual bar, indicate when each SD, RP and / or CR was observed as having occurred in the individual.
[001162] [001162] Complete resolution of the CNS involvement by lymphoma was observed in two patients. It was observed that the RAQ * cells in an individual expanded after the biopsy after relapse. The individual who exhibited expansion after biopsy had transformed chemoreceptor LDGCB (subtype of germinal center with a rearrangement of BCL2 and several copies of MYC and BCL6). The individual received the RAQ * T cells in the DL-1 and the T cell numbers
[001163] [001163] After receiving treatment with anti-CD19 RAQ-T cells, the subject achieved CR 28 days after the infusion, as shown by PET-CT (FIG. 6C) and brain magnetic resonance imaging (FIG. 6E), with no observed signs neurotoxicity or SLC. Three months after the infusion of RAQ-T cells, recurrence of the periauricular mass was observed in this individual (FIG. 6F) and an incisional biopsy was performed. As shown in FIG. 6A, after biopsy, the visible tumor receded without further therapy. Pharmacokinetic analysis showed a marked reexpansion of RAQ * T cells in peripheral blood (to a level higher than the initial observed expansion, with peak levels observed about 113 days after infusion) i, which coincided with tumor regression. The subject then achieved a second CR, as confirmed by the re-implanted PET-CT scans one month after the biopsy (FIG. 6G), and remained in the CR 6 months after the infusion of T-RAQ cells. Further evaluation of the individual showed that the CNS response was durable and the individual remained in CR at 12 months.
[001164] [001164] Results in the individual who received the biopsy followed by the observed reexpansion of RAQ * T cells are consistent with the conclusion that reexpansion and activation of RAQ * T cells can be initiated in vivo after reduction or loss of function or cells T RAQ * active and / or recurrence after antitumor response to RAQ-T cell therapy. In addition, after reexpansion in vivo late after the initial infusion of RAQ T cells ”, RAQ T cells * are able to re-exert antitumor activity. This result supports that the reexpansion and activation of RAQ * T cells can be triggered in vivo and that the methods of reactivation of RAQ * T cells can further increase their effectiveness.
[001165] [001165] Complete responses in the two LDGCB individuals with CNS involvement were observed without developing any degree of neurotoxicity. These results are consistent with the observation that the RAQ T cells * of the modalities provided here are capable of easily accessing the CNS and exerting an effective function to reduce or eliminate CNS tumors, without increasing or substantially increasing the risk of toxicity, as neurotoxicity. In other studies, among individuals who were treated with ALL with anti-CD19 RAQ T cells, no clear correlation was observed between the incidence of neurotoxicity and the presence of CNS leukemia in the brain (which was observed in response to this cell therapy T RAQ). Thus, while neurotoxicity may occur in some settings after treatment with RAQ-T therapies, that neurotoxicity may not necessarily be the result of target expression in the brain or T cell activity in the CNS RAQ and may not result from
[001166] [001166] Example 1.C.2 describes the results based on the time analyzed in example 1.A.2 and 1.B.2.
[001167] [001167] So far in Example 1.C.2, 68 individuals from the complete LDGCB cohort have been assessed for response. The rates of objective or general response (RO), of 3 and 6 months were 75% (51/68), 49% (27/55) and 40% (14/35), respectively. The complete response rate (CR), the 3-month CR rate and the 6-month CR rate were 56% (38/68), 40% (22/55) and 37% (13/35), respectively. There was a tendency to improve the response rate in 3 months in the subjects treated in ND2 compared to ND1: 63% (12/19; 95% of CI 38, 84) vs 40% (12/30; 95% of C | 23, 59) for TRG with p = 0.148 and 58% (11/19; 95% CI 34, 80) vs 27% (30/8; 95% CI 12, 46) for CR with p = 0.0385. Among 16 individuals with double or triple occurrence lymphoma, the RRT was 81% and the CR rate in three months was 60%.
[001168] [001168] In the main cohort (n = 49 for the period in the Example
[001169] [001169] The median PAIN in the complete cohort and in the central cohorts at this time in 1.C.2 was 5.0 and 9.2 months, respectively; The median duration of CR was 9.2 months in the complete cohort. The median duration of CR was not achieved in the main cohort. Mean overall survival (SG) was 13.7 months in the complete cohort and had not been achieved in the central cohort. The 6-month SG was 75% in the complete cohort, with an average follow-up of 5.8 months. The 6-month SG was 88% in the main cohort, with an average follow-up of 5.6 months. D. Evaluation of TRAQ * cells in the blood
[001170] [001170] Based on the time point data described in Examples 1.A.1, 1.B.1 and 1.0.1, pharmacokinetic analysis was performed to assess the number of RAQ * T cells in peripheral blood at various points of post-treatment time. Results of the fifty-five (55) individuals assessed at the time point in Example 1.A.1 in the LDGCB cohort and four (4) individuals (assessed at the same time point) in the coating cell lymphoma (CSF) cohort, as described in Example 2 below were analyzed. Pharmacokinetic measurements (PK) were performed using validated flow cytometry to detect a marker expressed in the RAQ construct and quantitative assays based on PCR to detect the integration of the RAQ construct. B cell aplasia was assessed by flow cytometry using anti-CD19 antibodies. As shown in FIG. 5A, CD4 * and CD8 * RAQ expression cells, measured by the number of cells / dlL of blood (median + quartiles) plotted on a logarithmic scale, were detected over the course of the evaluation at both administered dose levels. Individuals who received ND2 in relation to ND1 had a higher median Cmax and
[001171] [001171] An increased median area under the curve (AUC) (number of CD8 T cells * RAQ * over time in the blood) was observed among subjects who received the highest dose level compared to the dose level lower, without an observed increase in toxicity. A higher peak of exposure to CD8 * / RAQ * cells was observed in responders (CR / PR) than in non-responders (SD); cell persistence over the evaluation period, including 3 and 6 months, was observed even in individuals whose disease progressed (FIG.5B). The median Cmax and median AUCO0-28 of CD8 * RAQ * T cells were higher in individuals who responded and with a durable response in month 3 (median CD8 * Cmax = 20.8 vs. 5.5; median CD8 * AUCO0-28 = 235 vs. 55 in CR / PR in month 3 vs. SD in month 3). Among the individuals evaluated for the persistence of RAQ T cells, 90% and 93% of the 29 individuals had detectable CD8 * and CD4 * RAQ '* T cells, respectively, at month 3; 63% and 58% of 19 individuals had detectable CD8 * and CD4 * RAQ * T cells, respectively, at month 6. At months 3 and 6, no statistically significant differences were observed in the persistence of RAQ * T cells between individuals with lasting response or relapse. RAQ + T cells were detectable at the time of relapse in 89% of the 11 individuals with PK, although B cell aplasia (<1 cell / ul) was demonstrated in almost all individuals 97% (34/35) at month 3 and 100% (24/24) in month 6.
[001172] [001172] Cmax 6 AUCo-28 higher in ND2 compared to ND1 were not associated with increased SLC or NT. For any NT or> Grade 2 SLC, the median AUCs for CD4 * / RAQ * and CD8 * / RAQ * cells were 5 to 10 times and 3 to 5 times higher, respectively, than the median AUC for ND2. Higher disease burden and baseline levels of inflammatory cytokines were observed associated with higher levels of peak RAQ T cells *, higher levels of peak cytokines and higher incidence of SLC and NT. The results were consistent with the conclusion that the higher Cmax and median AUCo-2s in ND2 did not increase SLC or NT.
[001173] [001173] The results were consistent with the conclusion that the treatment resulted in prolonged exposure and persistence of the modified cells, even in individuals with weak responses. In some embodiments, combined approaches are used, such as administration of an immune checkpoint modulator or other immune modulating agent, for example, after relapse or disease progression, at a time when the modified cells persist in the individual, for example, as measured by the levels of cells in the peripheral blood. In some aspects, the cells, having persisted for a prolonged period, either expand again or activate and / or exhibit antitumor function, after the administration of the other agent or treatment. Higher mean numbers of CD4 * and CD8 * RAQ * T cells were generally observed over time in the blood of individuals who developed neurotoxicity (FIG.5C). The results indicated that the RAQ * T cells exhibited expansion and persistence, durability of the response in 3 months and increased at higher doses, without increased toxicity. Results were observed consistent with the suggestion that high peak levels of RAQ * T cells and cytokines in the blood may be associated with NT and SLC, and may be influenced by underlying factors. It was observed that RAQ * T cells were present at the time of relapse, indicating that combination or retreatment approaches can provide certain advantages. E. Blood and Neurotoxicity, SLC and Response Analyzes
[001174] [001174] Several pre-treatment blood assays, including cytokines, were measured in the subjects' serum (those assessed at the time point in Example 1.A.1), prior to administration of the RAQ T cells ”. Cytokines were measured using a multiplex cytokine assay. Potential correlations with the risk of developing neurotoxicity were assessed using statistical analysis based on univariate non-parametric tests.
[001175] [001175] FIG.7 shows the average levels of the analyzed analyzed in units (LDH, U / L; ferritin, in / mL; PCR, mg / L; cytokines, pg / mL) in individuals who did not develop neurotoxicity versus individuals who developed neurotoxicity after RAQ * T cell therapy. Levels of certain analyzed in the blood, including LDH, Ferritin, PCR, IL-6, IL-8, 11-10, TNF-a, IFN-02, MCP-1 and MIP-16, were found to be associated with the level of risk to develop neurotoxicity (Wilcoxon values p <0.05, without adjustment for multiplicity). In particular, the results were consistent with the conclusion that pretreatment levels of LDH, which in some modalities are a substitute for disease burden, may be useful for the potential assessment of the risk of neurotoxicity and / or dosage or adjustment adapted to the risk of treatment of certain individuals. In addition, the tumor load measured before the administration of the RAQ-T cell composition correlated (Spearman values p <0.05) with the risk of developing neurotoxicity. In some respects, LDH levels can be assessed alone and / or in combination with another pretreatment parameter, as another measure or indicator of disease burden, such as a volumetric measurement of tumors, such as the sum of product dimensions ( SDP) or other measurements based on CT or volumetric measurement based on magnetic resonance of the disease load. In some respects, one or more parameters indicative of disease burden are assessed and, in some contexts, may indicate the presence, absence or degree of risk of developing neurotoxicity after T-cell therapy. In some respects, the one or more parameters include LDH and / or a volumetric measurement of the tumor.
[001176] [001176] In an additional analysis, fifty-five (55) individuals in the LDGCB cohort at the time in Example 1.A.1 and four (4) individuals in the coating cell lymphoma (CSF) described in Example 2 below were included in the analysis for correlation with safety assessments. In the 59 individuals evaluated for safety, SLC was observed in 32% (30% Grade 1 - 2, 0% Grade 3, 2% Grade 4); NT was observed in 20% (5% Grade 1 - 2, 10% Grade 3, 5% Grade 4). The dose level did not correlate with SLC or NT (p = 0.565 and p = 1.00, respectively). The factors that correlate with any degree of SLC and NT were worse performance (for example, ECOG Status 2) (p = 0.03) and higher disease burden (p <0.05), as measured by the sum of the products of diameters (SPD) based on the results image. Clinical laboratory parameters of pre-RAQ * T cell infusion and cytokine measurements for pre-RAQ * T cell infusion that have been observed to be associated with the occurrence of any grade NT included higher serum LDH, ferritin and serum PCR, and IL-6, highest plasma IL -8, IL-10, TNF-a, IFN-a02, MCP-1 and MIP-18 (p <0.05 for each). Higher plasma levels of pre-RAQ * T cell infusion of IL-8, IL-10 and CXCL10 were also associated with Grade 3-
[001177] [001177] Of the 54 individuals in the LDGCB cohort who were assessed for response, higher ECOG scores and LDGCB transformed from CLL or LZM correlated with less durable response in month 3 (p = 0.02 for both). The pre-RAQ * T cell infusion parameters associated with the best RRT included lower values of ferritin, LDH, CXCL10, G-CSF and IL-10, and those associated with a durable 3-month response included less ferritin, PCR, LDH , CXCL10, 1IL-8, IL-10, IL-15, MCP-1, MIP-1B6, TNF-a and higher hemoglobin and pre-RAQ * T pre-RAQ * T infusion albumin (p <0.05 for each).
[001178] [001178] In some cases, the apheresis sample and the composition of RAQ * T cells for administration have been evaluated and correlated with clinical results. The results showed that the subsets of memory of T cells and the functionality of T cells can correlate with certain clinical results.
[001179] [001179] The results showed that certain baseline characteristics of the patient, including inflammatory status and high tumor burden before treatment, may be useful for identifying patients at risk for increased toxicity after administration of RAQ-expressing T cells. Low tumor load and low inflammatory status were associated with a better toxicity profile and better durability of the response. The results support that treating individuals early in the course of therapy and / or evaluating a panel of clinical and laboratory biomarkers to stratify individuals for possible early intervention can mitigate the risk of toxicity and improve the durability of the response. Example 2: Administration of anti-CD19 RAQ Expression Cells to Individuals with Coating Cell Lymphoma (CSF)
[001180] [001180] Therapeutic RAQ * T cell compositions containing autologous T cells expressing a CD19 specific chimeric antigen (RAQ) receptor, generated as described in Example 1, were administered to four (4) human subjects with cell lymphoma. coating (CSF) that had failed on 1 therapy line. The cryopreserved cell compositions were thawed prior to intravenous administration. The therapeutic composition of T cells was administered as a cell product of defined composition with formulated populations of CD4 * and CD8 * of T cells modified with RAQ '* derived from the same individual, administered at a target ratio of approximately 1: 1. To subjects a dose of RAQ expression T cells (as a divided dose of CD4 * and CD8 * RAQ expression T cells) was administered in a single dose of dose level 1 (ND1) containing 5 x 107 T expression cells of RAQ RAOQ. From three (3) days before the infusion of RAQ T cells *, individuals - received a lymphodeplective chemotherapy “with fludarabine (flu, 30 mg / m ) And cyclophosphamide (Cy, 300 mg / m ).
[001181] [001181] Subjects were monitored for response and toxicities, as described in Example 1. No SLC or neurotoxicity was observed in any of the subjects. Of the 4 treated individuals, two (2) individuals achieved PR (non-durable) and two (2) patients had progressive disease. Example 3: Additional Evaluation of Response, Safety, Pharmacokinetics, Pharmacodynamics and Blood Analyzes in Individuals with Recurrent and Refractory Non-Hodgkin's Lymphoma after Administration of Anti-CD19 RAQ Expression Cells
[001182] [001182] Response results, safety results, pharmacokinetic and pharmacodynamic parameters and blood samples were evaluated in patients at a subsequent time in the clinical study described in Example 1 above.
[001183] [001183] The analysis at this point in time presented in this example is based on the evaluation of a total of 91 individuals in the complete LDGCB cohort (88 (65 of the CORE cohort) assessed for response and 91 (67 of the CORE cohort) assessed for security) who were administered to anti-CD19 RAQ expression cells. The COMPLETE cohort included LDGCB, NOS again and transformed from any indolent lymphoma, ECOG 0-2; the MAIN cohort for analysis included individuals with LDGCB, NOS and transformed from follicular lymphoma (tLF) or high-grade B-cell lymphoma and with performance status from the Eastern Cooperative Oncology Group (ECOG PS) of O or 1. Approximately 90% of patients treated in the MAIN cohort had at least one disease characteristic of low risk predictive of short median overall survival (SG) of 3-6 months, as expressors of double / triple impact, primary refractory disease, refractory to 2 or more lines of therapy, never achieved CR, or never received autologous stem cell transplantation (TACT). In some modalities, a cohort of individuals with diffuse large B cell lymphoma (LDGCB) not otherwise specified (NOS; again and transformed from tFL follicular lymphoma)) or high grade B cell lymphoma, with MYC and BCL2 and / or BCL6 rearrangements with LDGCB histology and excluding individuals with an ECOG score of 2 or individuals - who have received previous hematopoietic stem cell (HSCT) transplants, are RAQ-T compositions administered as provided herein. In some modalities, individuals in the PRINCIPAL cohort receive anti-CD19 * RAQ T cells in a single dose of ND2 (1 x 10 th total RAQ expression T cells).
[001184] [001184] At that time, a total of 140 individuals had been leucafesado, of which 10 were waiting for manufactured composition, 2 had retired before manufacture and 2 had unavailable compositions. Of the other 18 individuals whose products were available, 4 were awaiting treatment, 4 had withdrawn and 10 had developed progressive disease or had died. A total of 108 individuals were administered anti-CD19 RAQ expression cells, of which 6 were not evaluable and 11 received non-compliant anti-CD19 RAQ expression cells (compositions that do not necessarily meet certain specifications, but are considered safe for administration). The subjects received ND1 (n = 45), double dose of ND1 (n = 6) or ND2 (n = 40). Six (6) individuals with lining cell lymphoma (CSF) received RAQ * cells in ND1 (five treated with product accordingly, one treated with nonconforming product) and five (5) completed 28 days of follow-up. One individual with LCM developed SLC and none received tocilizumab or dexamethasone. The product was available to 98% of the postulated individuals (126/128) in the LDGCB cohort.
[001185] [001185] Subjects at that time included 5 patients who were treated on an outpatient basis (including four (4) subjects treated with ND1, one (1) treated with ND2; four (4) of whom were included in the CORE cohort). For patients treated on an outpatient basis, the mean age was 57 years (range 26-61), 3 had LDGCB, NOS, 1 had tFL and 1 had LCBMP. All five (5) subjects had an ECOG score of O or 1. Outpatient outcome data included results for three (3) additional subjects who were treated in the outpatient setting (total of eight (8) subjects) and whose data became available after the time point for the analysis in this example.
[001186] [001186] The demographic and baseline characteristics of individuals in the complete and main cohort at the moment are shown in Table E5.
[001187] [001187] As shown in Table E6, the objective response rate
[001188] [001188] As shown in Table E7, high response rates and low severe toxicity have been observed in the complete LDGCB population.
[001189] [001189] As shown in Table E8, a high response rate and a dose-dependent response were observed in the MAIN cohort of individuals. Table E8. Durable Response After RAQ Cell Administration * [o | NwveisdeDose | Nois | NDas | ORR (95% CI),% 80 (68, 89) 77 (59.89) 82 (62, 94) CR (95% CI),% 55 (43, 68) 47 (30, 65) 63 ( 42, 81) 3-mo TRG (95% CI),% 65 (51.78) 59 (39, 77) 74 (49, 91) 3-ma RC (95% CI),% 54 (40, 68) 41 (24.61) 68 (43, 87) 6-mo TRG (95% CI),% 47 (31, 64) 40 (19, 64) 50 (23, 77) 6-ma RC (95 % Cl),% 42 (26, 59) 30 (12, 54) 50 (23, 77) Four patients (CORE) treated with ND1D with similar results.
[001190] [001190] Three-month objective response rates (ORT) among various subgroups of individuals in the low-risk LDGCB subgroups, which included all patients with LDGCB treated at all dose levels in the central cohort, are shown in FIG. 22. The results showed a high durable ORT in the low-risk LDGCB subgroup.
[001191] [001191] Results for duration of response (DOR) and overall survival (grouped by best overall response (non-responder, CR / PR, RC and / or RP)) are shown for the full cohort and the main cohorts of individuals , in FIGS. 23A-23D. The results also showed that 80% (16/20) of individuals with CR at 3 months remain in CR at 6 months and 92% (11/12) of individuals with a response (CR or PR) at 6 months continue to show a response to long term.
[001192] [001192] FIG. 24 shows the percentage of individuals at that time who observed laboratory abnormalities and adverse treatment emergent events (EAETs) (data from 5 patients with LCM treated with product in compliance with ND1 with at least 28 days of follow-up are not included). In addition to the EAETs shown in FIG. 24, the following terms of the event were observed in Grade 3-4 in 25% of patients: encephalopathy (8%), pancytopenia (5%) and febrile neutropenia (7%). Eight patients (9%) had infusional toxicity, defined as AS on the day of administration related to the administration of RAQ * cells, including flushing, headache, fever, pyrexia, chills, stiffness, vomiting, skin rash, itchy urticaria, hypotension, wheezing, bronchospasm, shortness of breath, nausea, vomiting, back pain, cough and reaction to the infusion. Events included chills (2), pyrexia (5), flushing (1), headache (1), hypotension (1), infusion-related reaction (1), rash (1), itching (1) and vomiting (1), with 6 events from the 1st series, 1 from the 2nd series (chills) and 1 from the 3rd series (hypotension). EAET in the main cohort did not differ substantially from those in the full cohort. The most common related EAETs in individuals treated in the outpatient group were SLC, hypotension, vomiting, anemia and dyspnea.
[001193] [001193] Table E9 shows the EAETs and neurotoxicity that occurred in 25% or more individuals in the COMPLETE or CORE cohort, for individuals who received ND1IS and ND2S. No apparent dose-toxicity relationship was observed in the LDGCB population. MAIN per dose level.
[001194] [001194] FIG. 25 describes the number and percentage of individuals who were observed to have SLC and / or NT at various times after the administration of RAQ cells *. In this evaluation, the median time to the start of the first SLC or NT event was 5 (range 1 - 14) or 10 (range 3-23) days, respectively. In the first 72 hours after administration of RAQ cells ”, 1 patient had NT (grade 1) and only 14% (13 of 91) had SLC (7 grade 1; 6 grade 2). The median duration (Q1, Q3) of the SLC or NT was (4, 8) or 10.5 (7, 19) days, respectively. NT was preceded by SLC in 12 of the 17 cases (71%). All assessed NT events were resolved at the time of analysis, except for a grade 1 tremor and 2 patients died of progressive NT disease in progress (based on the safety database of reported events, including additional individuals analyzed after the point analysis described in this example).
[001195] [001195] In the complete cohort (n = 91), selected individuals with initiation of SLC or NT received anti-cytokine therapy with tocilizumab and / or dexamethasone, as follows: Tocilizumab alone, 4% (n = 4); Dexamethasone alone, 9% (n = 8); Tocilizumab and dexamethasone, 8% (n = 7). The average number of doses of dexamethasone was 6 (range 2-99); and the average number of doses of tocilizumab was 1 (range 1 - 3).
[001196] [001196] Table E10 shows the results of toxicity in subjects from the MAIN cohort who received a single dose in ND1 or ND2. No deaths occurred by SLC or NT. The average time to start SLC was 5 days (range 2 to 14) and NT was 11.5 days (range 5 to 23). In the CORE cohort, 13% (n = 9) received tocilizumab and 18% (n = 12) received dexamethasone to improve toxicity. Eighteen percent of individuals (12 of 67) exhibited terms of neurotoxicity consistent with encephalopathy, including encephalopathy (13%), 6% (4 of 67) had aphasia and 3% (2 of 67) had seizures. In Table E10, the number of subjects or% of the total subjects (parentheses) exhibiting an indicated toxicity result is shown at all dose levels or specifically at subjects who received ND1 or ND 2. The upper and lower 95% confidence intervals are also shown in brackets. Table E10. Main Cohort Toxicity That Receive Different All Dose Levels * Es SLC, n (%) [95% CI] asse Toa as | o Any Grade 14 (21) [12, 33] 8 (24) 11, 41] 5 (17) [6, 36] Grade 1/2 4 (6) 2, 15] 1 (3) [0, 15] 3 (10) [2, 27] SLCg or NTg, n Four patients treated with ND1D with similar results. Includes confusional state, encephalopathy, aphasia, ataxia, cerebellar syndrome, delirium, depressed level of consciousness, dizziness, smooth effect, impaired hand-eye coordination, impaired memory, tremor, agitation, attention disorder, dysarthria, changes in mental status , muscle weakness, seizure, drowsiness and urinary incontinence.
[001197] [001197] Among twelve (12) individuals who received non-compliant products, 10 on ND1 and 2 on ND2, all were followed up for 28 days. SLC was observed in 33% of the individuals (4/12) and NT was not observed in any of the individuals. Two subjects received tocilizumab and three subjects received dexamethasone. The toxicity rates were comparable to those observed in the larger cohort of individuals who received products accordingly. In individuals who received non-conforming products, pharmacokinetic expansion (PK) was greater in individuals with SLC / NT, individuals with high tumor burden or LDH levels. C. Evaluation of Ambulatory Administration
[001198] [001198] Data from a total of eight (8) subjects were currently assessed on an outpatient basis (mean age 58.5 and ECOG of O or 1) at various clinical sites, including three subjects whose data were available subsequent to the point of the time analyzed for the purposes of this Example. The mean hospitalization time was 15.6 days for patients treated on an outpatient basis (SD 9.6, n = 86) and 9.3 days for patients treated on an outpatient basis (SD 11.9, n = 8 ). A 40% reduction in hospital stay was observed in individuals treated on an outpatient basis. The average number of days before hospitalization after ambulatory administration of RAQ * T cells was 5 days (range: 4-22). None of them required admission to the intensive care unit (ICU) after outpatient administration.
[001199] [001199] Among the 8 outpatients treated with more than 28 days of post-administration follow-up, | remained outpatient throughout the dose-limiting toxicity period. Seven (7) patients were admitted with fever (1 on day 4 of the study, the remainder on study day 2 5), 6 patients were admitted with SLC (4 grade 1, 2 grade 2) and 2 patients with NT grade 1. No patient had severe SLC or NT. One (1) patient was treated with tocilizumab without dexamethasone for SLC (note 2) and no patient was treated with dexamethasone for SLC or NT. One patient was admitted three days after the administration of RAQ T cells ”*.
[001200] [001200] Among 91 individuals treated in hospital and outpatient settings, 11 individuals (12%) required admission to the ICU for treatment of toxicity; 8 individuals (9%) required admission to the ICU to treat SLC or NT; 2 individuals (2%) required admission to the ICU to treat acute respiratory events (one related to the administration of RAQ T cells *, one unrelated). Six (6) individuals (6%) were intubated (based on the safety database of reported events, including additional individuals analyzed after the point of analysis described in this example; n = 94); 7 individuals (7%) received vasopressors (based on the safety database of reported events, defined as exhibiting hypotension in the first 28 days after administration of RAQ T cells ”*, in the TEAE assessment); and 2 individuals (2%) underwent hemofiltration (based on the safety database of reported events). The results showed that very few patients required care at the ICU level and associated procedures. The results supported the feasibility of outpatient administration, with safe management of toxicity in the outpatient environment, adequate education and outpatient monitoring.
[001201] [001201] The assessment of outpatient administration supported the feasibility of safe outpatient administration. 30% of individuals were not admitted again. D. Pharmacokinetic Evaluation
[001202] [001202] Numbers of RAQ * T cells in peripheral blood and bone marrow moments before administration (pre-treatment or pre-lymphadenectomy chemotherapy (LDC)) and several times in the post-treatment (with day of administration as day 1) in 87 individuals from the LDGCB cohort with evaluable PK, by flow cytometry using a specific antibody for the truncated receptor used as a substitute marker and quantitative polymerase chain reaction (qPCR) using specific primers for a post-regulatory element
[001203] [001203] FIG. 9A shows detected numbers of RAQ T cells per microliter of blood at various times indicated, as assessed by qPCR or flow cytometry. FIG 9B shows RAQ * cells per microliter of blood versus microliter of bone marrow on day 11 * 3. As shown in FIG. 9A, the levels of RAQ expression cells in samples from individuals were observed by assays based on flow cytometry and assays based on qPCR. As shown in FIG. 9B, all subjects (n = 86 and 85 for flow cytometry and qPCR, respectively, excluding one patient who had no available flow cytometry results and 2 patients who had no available qPCR results) with assessed PK results, showed detectable numbers of RAQ expression cells in blood and bone marrow. The results were consistent with the observation that CAR * T cells had traveled in a similar way to bone marrow and blood.
[001204] [001204] The levels over time of cells that express
[001205] [001205] AUCo-2s is Cmax for RAQ expression cells CD3 ”, CD4 * and CD8 * were also compared with subjects who received dose level 1 (ND1; n = 32) and those who received dose level 2 (ND2; n = 27), in the MAIN cohort (individuals with LDGCB, NOS or high grade B cell lymphoma (double / triple hit); N = 59). As shown in FIGS. 11A and 11B and in Table E11, a higher median AUCo-28s was observed for RAQ expression cells CD3 *, CD4 * and CD8 * in subjects who received ND2, compared to subjects who received ND1. Likewise, a trend of greater expansion in individuals who received ND 2 was observed in the complete LDGCB cohort. Greater durability of the response (DOR) was also observed in 3 months among individuals who received ND2 compared to those who received ND1, without increased toxicity. The mean time to Cmax (Tmax) for CD4 * and CD8 * RAQ * cells was similar between subjects who received ND1 and ND2.
[001206] [001206] Greater exposure to RAQ * T cells was observed in ND2 versus ND1, corresponding to increased response durability without increased toxicity in individuals with ND 2. Table E11, Pharmacokinetics in Individuals Grouped by Dose Levels in the main cohort ND1IS ND2S Total, NDISe (n = 32) (n = 27) ND 2S (n = 59) Cmax, median 48.2 96.2 65.8 ( cells / uL) Min, max 0.17726.3 1.1, 1280.9 0.1.7726.3 (days) Min, max 9.24 8.31 8.31 median (cells * day / uL ) | ea | 1659/9993 | 155.8.36283 | 155,8,3381,9 | cD4 * (cells / uL) Min, max 0.1, 3039.9 0.2, 169.4 0.1, 3039.9 Tmax, median 14.0 15.0 15.0 (days) Min, max 8 , 24 8.31 8.31 median (cells * day / uL) 01.03 26.4, 274.7 18.1.679.0 23.9.368.8 (cells / uL)
[001207] [001207] The persistence of RAQ expression cells and aplasia of CD19 * B cells (low number or absence of CD19 * B cells) was evaluated at various times in evaluable individuals with LDGCB who were administered RAQ T cells *, based on in CD3 ”*, CD4 * detectable or Cell Levels expressing CDB8 '* RAQ and CD19 * B cell levels detected in the blood, respectively. The results are shown in Table E12. Among the individuals evaluated in progression (progression time, regardless of BOR; n = 37), a median of 0.17 CD4 * RAQ * / UL cells (range, 0-65.5 cells / UL) and a median of 0 , 15 CD8 * RAQ * cells / uL (range, 0-131.8 cells / mL) were observed in progression. Among the individuals assessed for recurrence (at the time of progression after reaching CR) (n = 12), a median of 0.17 / UL (range, 0-35.1 cells / uL) of CD4 * cells expressing RAQ and a median of 0.20 cells / ul (range, 0-131.8 cells / uL) CD8 * RAQ expression cells were observed in long-term persistence of RAQ expression cells relapse in 75% of subjects evaluable with LDGCB in 12 months. Long-term persistence of B-cell aplasia was also seen in 75% of subjects at 12 months and in individuals regardless of relapse status. The results are consistent with the conclusion that anti-CD19 RAQ expression cells exhibited long-term persistence in most individuals and suggest the potential for continuous, low-level control of the disease, even in relapsed patients.
[001208] [001208] Of the individuals who relapsed, 91.7% (11/12) had detectable RAQ expression cells in the blood at the time of relapse. This result is consistent with the conclusion that a combination therapy or other intervention in some modalities can be used to enlarge and / or increase RAQ expression cells, such as those that may be exhausted. In Progression | Persistent relapse of RAQ 50 30 18 12 37 12 T in evaluated patients, n [en% | soo [7000 [566 [500] es | 750 | B cell aplasia 93.3 77.8 75.0 97.3 100 CcD19 * (<1 cell / uL),% G Pharmacokinetic Evaluation and Toxicity
[001209] [001209] AUCo-2s and Cmax of CD4 * and CD8 * RAQ expression cells were also compared for individuals in the main cohort with any grade (in this assessment, any grade 1 - 4; no SLC or NT grade 5) syndrome cytokine release (SLC) or neurotoxicity (NT) to individuals who have not been evaluated as exhibiting any degree of SLC or NT. The median CD4 * RAQ * AUCo-x6s (Q1, Q3) was 59 (18, 210) for any SLC (grade O; n = 43) and 267 (91, 1510) for any SLC (grades 1 - 4; n = 20) (p = 0.001); the median CD8 * RAQ * AUCo-2s (Q1, Q3) was 310 (36, 900) for SLC (grade O; n = 43) and 605 (174, 5619) for any SLC
[001210] [001210] The number of CD3 * RAQ * peak / ulL cells (Cmax of CD3 *) was assessed over time in subjects who had a better overall response (MRG) of RC, RP or DP. As shown in FIGS. 13A and 13B, a trend towards better MRG was observed in individuals with greater expansion, with variability between individuals.
[001211] [001211] Plasma cytokine levels in pre-RAQ * treatment of T cells (pre-lymphoplete chemotherapy), including interleukin-7 (IL-7), I1L-15, macrophage inflammatory protein (MIP-10), were assessed in subjects who exhibited a RAQ * CD3 * Cmax in the blood> 500 RAQ * / UL T cells (N = 55) compared to subjects who exhibited a RAQ * CD3 * Cmax in the blood <500 RAQ * / UL T cells (N = 7). As shown in FIG. 14A, it was observed that elevated plasma cytokine levels in the pre-RAQ * treatment of T cells were associated with RAQ Cmax * CD3 *> 500 RAQ * / UL T cells (Wilcoxon P values <0.05 (without multiplicity adjustment); except IL-7 p = 0.07).
[001212] [001212] Peak levels of various plasma cytokines (IL-6, IL-10, I1L-16, interferon gamma (IFN-y), tumor necrosis factor alpha (TNF-a), MIP-10, MIP-16, monocyte chemo-attracting protein-1 (MCP-1) and chemotherapy with motif CXC 10 (CXCL10)) were also evaluated in subjects who exhibited Cmax in the blood of RAQ * CD3 *> 500 T cells RAQ + / UL (N = 68) in comparison with individuals who exhibited Cmax in the blood of RAQ * CD3 * <500 RAQ T cells * / UL; N = 9). As shown in FIG. 14B, it was observed that higher levels of peak cytokines were associated with Cmax of RAQ * CD3 *> 500 RAQ * / UL T cells (Wilcoxon P values <0.05; without adjustment multiplicity).
[001213] [001213] Relationship between pre-RAQ * T-cell treatment (pre-lymphoid chemotherapy) (LDC), volumetric sum of product size tumor measurements (SDP), as an indicator of tumor burden, and AUCo-2s of CD3 * RAQ * T cells, representing T RAQ + exposure over time, were evaluated. As shown in FIG. 15, a positive correlation was observed between baseline SDP and CD3 * AUCo-28, with a Spearman correlation of 0.32 and p = 0.019.
[001214] [001214] Levels of treatment analysis with pre-RAQ * T cells (pre-LDC), including cytokines and inflammatory markers such as Ferritin, C-reactive protein (CRP), D-dimer (fibrin degradation product), IL-6, I1L-10, I1L-15, IL-16 TNF-a, MIP-1a and MIP-16 were compared for individuals with any grade of cytokine release syndrome (SLC) or neurotoxicity (NT) (here, grade 1 - 4 ) or individuals with neurotoxicity (NT) did not have SLC or NT (grade O). In this cohort, among individuals with SLC grade 1 - 4, all events, with the exception of one, were determined to be grade 1 or 2. As shown in FIG. 16A (SLC) and FIG. 16B (NT), an association was observed between the highest levels of plasma cytokines and the inflammatory markers associated with SLC and NT,
[001215] [001215] The parameters of the patient before treatment (pre-LDC), such as lactate dehydrogenase (LDH) levels and a volumetric measurement of the tumor, as a sum of the product dimensions (SDP), as an indicator of the tumor load, were compared between individuals who were not observed to have developed SLC or neurotoxicity versus individuals who were observed to have SLC or NT. As shown in FIG. 17, individuals with SLC or NT exhibited higher levels of pre-treatment patient parameters, such as SDP (cm ) And LDH (U / L) levels; It was observed that these levels were correlated with SLC or NT, with univariate statistical analysis. Other patient parameters that were observed to be associated with SLC and NT include shorter time since diagnosis (p = 0.05 and p = 0.09, for SLC and NT, respectively). Patient parameters that were not associated with SLC or NT included age (p = 0.19 and p = 0.54, r number of therapies (p = 0.67 and p = 0.59, respectively), disease stage 0 -2 vs 3-4 (p = 0.79, p = 0.51) and patient weight (p = 0.35 and p = 0.44, respectively).
[001216] [001216] FIG.18A shows the pretreatment SDP and LDH levels between individual patients (points; with shading of individual points indicating whether or not the patients did and did not show —neurotoxicity grade (left panel) or if they did not have SLC degree (right panel) In Figure 18A, dashed lines on the y and x axes delimit SDP> 50 cm cm and LDH> 2500 U / L, respectively. As shown in Figure 18A, an SDP of approximately 50 cm or greater, and / or an LDH of approximately 500 U / L or higher, were found to be associated with the risk of NT and SLC Calculated estimates of the non-occurrence probability ratio for the development of SLC or NT in individuals above or below SDP and LDH levels indicated by dotted lines in FIG. 18A, with 95% confidence intervals (CI), are represented in FIGURES 18B and 18C. A non-occurrence probability ratio above 1 indicates an increased probability or probability of developing SLC or N T. As shown, 50 cm SDP or higher, LDH of 500 U / L or higher, has been observed to be associated with increased risk of developing ping SLC or NT. It was observed that the SDP of 50 cm or higher and LDH of 500 U / L or higher were associated with an approximately 8-fold increased risk of developing any grade SLC and NT, and SDP less than 50 cm and LDH less than 500 U / L showed a reduced risk of SLC and NT to any degree. The results were consistent with an association of baseline parameters of patients, including high tumor burden and inflammatory biomarkers, with expansion of RAQ '* T cells and increased rates of SLC and neurotoxicity.
[001217] [001217] Various parameters of the pre-treatment patient (pre-LDC), including markers associated with tumor load (SDP), inflammatory cytokines and other blood samples, including LDH, ferritin, CRP, D-dimer, SAA-1, IL-6 , IL-10, IL-15, IL-16, TNF-a, IFN-y, MIP-1a and CXCL10, were compared for individuals with and without lasting response in 3 months, with univariate statistical analysis. As shown in FIG. 19, certain tumor burden markers, inflammation markers or inflammatory cytokines were lower in individuals who exhibited a durable response (p value <0.05 for all parameters, except SDP (p = 0.1274)). Similar results were observed in individuals who received ND 2,
[001218] [001218] The relationships between patient factors, clinical correlates and blood samples for the development of SLC and NT degrees were assessed using statistical analysis based on univariate non-parametric tests. Table E13 lists the results of the univariate analysis. In this assessment, age <40 years and no previous HSCT correlated with the incidence of SLC or NT. It was not observed that individuals aged <40 years had statistically different rates of greater tumor burden than older patients. Individuals with ECOG score 2 did not show statistically different rates of higher tumor burden compared to individuals with ECOG score 0-1. Those without previous HSCT or doubleftriple hit or double expressor were not associated with SLC or NT. Table E13. Univariate Analysis of Key Subgroups
[001219] [001219] Maximum plasma levels of post-treatment of analyzed in the blood, including cytokines and inflammatory markers, such as CRP, amyloid serum A1 (SAA-1), IL-2, IL-6, I1L-10, IL-15, TNF -a, MIP-1a, MIP-1B, MCP-1, CXCL10 and CC Reason Chemokine Ligand 13 (CCL13) were compared in individuals with grade 1 - 4 cytokine release syndrome (SLC) or neurotoxicity (NT) in individuals who have not been observed it has some SLC or NT. As shown in FIG. 20A (SLC; SLC grade O, n = 51; SLC grades 1 - 4, n = 28) and FIG. 20B (NT; NT grade O, n = 63; NT grades 1 - 4, n = 16), it was observed that higher levels of plasma cytokines and inflammatory markers were associated with SLC and NT (Wilcoxon P values <0.001 for absence of SLC vs. any SLC and for no NT vs. any NT, except IL-15 (P = 0.05 and 0.006, respectively)).
[001220] [001220] Maximum plasma levels of analyzed in the blood, including cytokines and inflammatory markers, such as CRP, SAA-1, IL-5, IL-6, IL-7, IL-7, IL-8, 11-15, Lymphotoxin alfa (LT-a), TNF-a, IFN-y, MIP-1a, MIP-1B, MCP-1, CXCL1I0 and transforming growth factor beta (TGF-B), were evaluated for individuals with the best overall response (MRG) complete response (CR) or partial response (PR) (N = 57) compared to levels in individuals with stable disease (ED) or progressive disease (PD) (N = 17); or for individuals with ED or PD at 3 months (SD / SD) (N = 31), compared to individuals who exhibited CR / PR at 3 months (N = 35). As shown in FIG. 21A (best overall response (MRG)) and FIG. It was observed that 21B (response at month 3), lower peak plasma cytokine levels and levels of inflammatory markers were associated with better MRG and response at month 3 (Wilcoxon P values <0.05 without multiple adjustment) .
[001221] [001221] In this study, administration of anti-CD19 RAQ * cell compositions was administered to individuals with relapsed / refractory aggressive non-Hodgkin's lymphoma (NHL) who have low disease risk characteristics. Responses were observed, including durable responses, including 81% RRT, 63% CR at ND2, with 80% of patients at CR at the remaining 3 months at CR at 6 months at all dose levels, median PAIN of subjects treated in all dose levels 9.2 months, with the average duration of CR not reached at the time of analysis in this example. The results were also consistent with manageable levels of toxicity and a favorable safety profile that, in some modalities, may be consistent with outpatient administration. Low rates of severe SLC (1%) and severe neurotoxicity (12%) were observed, with few events in the first 72 hours. The results were consistent with the feasibility of outpatient administration.
[001222] [001222] Pharmacokinetic evaluations showed that further expansion of RAQ * T cells was generally associated with increased rates of SLC and NT. Individuals who received ND2 had greater exposure to RAQ T compared to individuals who received ND2, which generally corresponded to longer durability of the response without a higher incidence of toxicity. In some aspects, it has been observed that pre-treatment, such as pre-LDC, patient factors, including homeostatic and inflammatory cytokines and tumor burden, are associated and / or generate very high expansion and toxicity. The RAQ * T cells administered showed expansion in the blood and bone marrow of all patients, with variability between individuals and between types of diseases. The administered RAQ T cells * also exhibited long-term persistence, with 75% (9/12) of evaluable patients having detectable RAQ T cells at 12 months. It was observed that RAQ T cells and B cell aplasia were still present at the time of relapse (11/12 and 12/12 patients, respectively), supporting that tumors can prevent the action of RAQ T cells and that combination strategies they can be effective in preventing relapse or increasing, strengthening or enhancing depleted RAQ T cells. In general, a trend of greater response was observed with greater expansion, with variability between individuals, supporting that other factors of the patient and / or characteristics of the disease, for example, tumor burden, may contribute to determine the response.
[001223] [001223] Exemplary therapeutic T cell compositions containing autologous T cells expressing a CD19 specific chimeric antigen (RAQ) receptor, used for administration in Examples 1 and 2 above, have been evaluated for more than one hundred phenotypic, functional and related attributes cell health, using flow cytometry and in vitro assays. Therapeutic cell compositions generated for individuals enrolled in a clinical study evaluating anti-CD19 RAQ-T cell therapy for treatment of relapsing / refractory B-cell non-Hodgkin's lymphoma were examined (N = 63; core cohort). The cells were evaluated before and after engineering, for various attributes. Exemplary attributes that have been evaluated are shown in Table E14. RAQ T cell memory and cell health phenotypes were examined using flow cytometry. The functionality of T cells was evaluated using bioassays specific for antigens in vitro. The characterization and release tests were performed on therapeutic T-cell compositions that had undergone a representative number of freeze-thaw cycles.
[001224] [001224] For generation of cell compositions for administration, autologous cells were isolated from individuals via leukapheresis. The leukapheresis samples were subjected to a process to generate RAQ expression cells. The process involved washing cells using automated selection based on washing and immunoaffinity for purification of CD4 * and CD8 * T cells, resulting in two compositions enriched for CD8 * (in which a median of 99%, interquartile range (IQR) 98 - 100%, the cells were CD8 *) and CD4 * (in which a median of 99%, IQR 99-100%, the cells were CD4 *), respectively.
[001225] The cells of the enriched CD4 * and CD8 * compositions were subjected separately to lentiviral transduction with a vector encoding an anti-CD19 RAQ with a 41BB co-stimulatory domain. The transduced populations were then incubated separately in the presence of stimulating reagents for cell expansion. The expanded CD8 * and CD4 * cells were formulated and cryopreserved separately and stored before administration. To minimize variations, between batches and / or compositions of cells derived from different patients, such as those with different patient attributes, in parameters indicative of cell health, the cells were kept in constant volumes between batches. Cellular products exhibited a narrow range of viable cell concentrations (based on the evaluation of cell compositions for a group of individuals, CD8 *: median 31 x 10 th cells / mL, IQR 28-40 x 10 th cells / mL, N = 38; CD4 *: median 35 x 108 cells / mL, IQR 31-40 x 10º, N = 36).
[001226] [001226] As shown in FIG. 26 and summarized in Table E15, automated T cell purification resulted in pure CD8 * and CD4 * T cell populations. This strategy reduced the probability of non-T cell transduction and resulted in high T cell purity in the therapeutic cell composition regardless of the duration of the expansion. ss hand process [reco [ecramee Purification | Process | de Fármaco ea fu fes ato ua | CD4 * go es us and oia | CD8 *
[001227] [001227] At the administration site, the cell compositions were thawed and administered separately, according to a target volume of each composition corresponding to the number of CD8 * RAQ * and CD4 * RAQ * cells in the appropriate dose (as for ND1, containing 5 x 107 total RAQ expression T cells (2.5 x 107 each of the RAQ expression CD4 * and CD8 * cells) or ND 2, containing 1 x 10th total RAQ expression T cells (5 x 107 each one of RAQ expression CD4 * cells and RAQ expression CD8 * cells)).
[001228] [001228] During the clinical trial, there was a process change from a high volume formulation to a low volume formulation. The post-change therapeutic cell composition was formulated at a constant low volume, with a tightly controlled range of viable cell concentrations. In some cases, a low volume formulation was used instead of a high volume formulation. Indicative health parameters of RAQ expression T cells in compositions for administration were evaluated, such as measuring, post-thaw, viability, cell surface Annex V expression and active intracellular Caspase 3 levels, in cell compositions that were formulated with high volume and low volume.
[001229] [001229] The change of the process from the high volume formulation to the low volume formulation resulted in greater robustness of the process and less variability of the cellular health attributes. Values for concentration, percentage of viable cells and percentage of active caspase-3 negative cells between CD4 * and CD8 * T cells of individual cell compositions are shown in FIGS. 27A-27C and are summarized in Table E16. The average percentage of Annex V expression cells was 11% (IQR 9-18%; N = 33) of CD8 * RAQ '* T cells and 10% (IQR 8-17%; N = 31) of T cells CD4 * RAQ ”. The expression of caspase 3 was similar to that of annex V. The change to the low volume formulation resulted in greater robustness of the process and reduced the variation in the health attributes of the cells. Table E16: Cell Health Attributes High Low High Low Volume | Volume of | Volume of | Formulation Volume | Formulation | Formulation | Concentration Form - Carbons 15.9-19.3 31.7-40.4 10.9-15.3 28.5-38.0 x cells / mL Viability | Median 82.5 72.0 cellular% | 1oR | 795-847 | 804843 | 693-766 | 76,4-833 [Eee mean | and [6 me "the SS | Negatives to Caspase- 3
[001230] [001230] The quantities of RAQ * CD4 * and RAQ * CD8 * T cells in the composition for administration were precisely controlled. It was observed that the number of cells actually administered to an exemplary set of individuals was within 8% or less of the target number of cells for a given dose: * 2.4-2.7 x 107 (target + 8%) cells CD4 * RAQ * and 2.4-2.7 x 107 (target + 8%) T cells CD8 * RAQ * for individuals administered in ND1 cells (n = 48) * 4.6-5.1 x 107 (target + 8%) CD4 * RAQ * cells or 4.6-5.1 x 107 (target + 8%) CD8 * RAQ * cells for individuals administered in ND2 cells (n = 20).
[001231] [001231] It was found that the administered dose range has low variability in a different exemplary set of individuals: * 48-52 x 106 CD3 T cells * RAQ * in ND1 (n = 34) * 96-101 x 106 T cells CD3 * RAQ * in ND 2 (n = 29) * 24-27 x 10º CD4 * RAQ * cells or CD8 * RAQ * in ND1 (n = 34) * 46-51 x 106º CD4 T cells * RAQ '* or CD8 * RAQ * in ND2 (n = 29).
[001232] [001232] As shown in FIG. 28A, it was observed that RAQ expression T cell compositions administered to individuals exhibit high T cell purity and low variation between batches. In view, for example, of process and product controls, it was observed that therapeutic cell compositions containing RAQ T cells have low batch-to-batch variability in cell-specific T cell function.
[001233] [001233] The accumulation of antigen-specific cytokines in vitro and intracellular cytokine staining (ICS) showed a similar low variation between batches for cytokine production for multiple cytokines (IL-2, TNF-a and IFN-y). In an example of an ICS experiment, the cells in the compositions were stimulated with CD19, stained for cytokines, including TNF-a and surface proteins, including the CC chemokine receptor type 7 (CCR7) as a marker of memory phenotype and analyzed by cytometry flow. The number of cells in the composition for administration that were positive for cytokines or surface proteins was determined. FIG. 28B shows the number of CD4 * RAQ * and CD8 * RAQ ”* cells, CD4 * RAQ * TNF-a * and CD8 * RAQ * TNF-o *, CD4 * RAQ * CCR7 * and CD8 * RAQ * CCR7 * cells and present in RAQ T cell compositions for administration in ND1 and ND 2. These results are summarized in Table E17. The results show low variability in the number of CD4 * RAQ * and CD8 * RAQ ”*, CD4 * RAQ * TNF-a * and CD8 * RAQ * TNF-a *, CD4 * RAQ * CCR7 * and CD8 * RAQ * cells CCR7 *. For example, a narrow range was observed for the number of cells positive for TNF-a production (n = 61). oro ro SE RE E and TNF-a TNF-a CCR7T CCR7T | - | not | no2 | at the! | walnut [walnut walnut | nDI Walnut not | walnut | not | walnut | fussiana 257 | 504 [250 so0 [280 was [199 n17 1] 166 [so 160 24,7- | 49.6- | 24.8- | 49.6- | 21.3- | 46.6- | 18.3- | 39.9- | 5.5- | 11.0- / 3.0-14.8 / 8.6-25.3 [5 [55 5 so [55 to A as ts | the Plague:
[001234] [001234] A parameter indicative of RAQ * cell production of tumor necrosis factor alpha (TNFa) after stimulation with CD19 showed a narrow range between different batches, with a relative standard deviation (RSD) of 37% for CD4 * RAQ 'T cells. * (N = 59) and 51% for CD8 T cells * RAQ * (N = 61).
[001235] [001235] The results were consistent with the observation that a composition that contains an accurate and consistent dose of CD4 * and CD8 * RAQ T cells, control and optimization of CD4 * and CD8 * T cell culture conditions, low variability of cytokine production and / or constant formulation and volume of the composition for administration can lead to cell health consistent in the composition. In the modalities provided, aspects of this manufacturing and control process contribute to the low variability in the attributes of such cell compositions modified using cells from, and generated for administration to, a number of different individuals. Such aspects in some aspects include the use of an accurate and consistent flat dose of CD4 * and CD8 * cells administered between individuals; control and optimization of CD4 * and CD8 * T cell culture conditions, such as those that result in low variability between drug batches between phenotypes (eg, CCR7) and in vitro function (eg, production of IL-2, TNF -a and IFN-y after antigenic stimulation), as between different individuals; and the use of constant drug formulations and volumes that can result or contribute to the consistency between therapeutic cell compositions generated by the method in attributes indicative of cell health. Example 5: Evaluation of Biomarkers in Pre and Post-Tumor Biopsies of Individuals with Recurrent and Refractory Non-Hodgkin's Lymphoma (NHL) for Administration of Anti-CD19 RAQ Expression Cells
[001236] [001236] The expression of several biomarkers was evaluated in tumor biopsies collected from individuals before and / or after the administration of RAQ expression cells. A. Tumor Biopsy Samples
[001237] [001237] Tumor biopsies were collected from selected individuals with diffuse relapsed or refractory large B cell lymphoma (R / R) or liner cell lymphoma (CSF) that received treatment with therapeutic T cell compositions
[001238] [001238] The infiltration of RAQ * T cells in the tumor biopsy was quantified using MRNA-specific in situ hybridization probes (ISH) encoding the anti-CD19 RAQ. RAQ T cells ”, non-RAQ T cells and B cells were enumerated using multiple immunofluorescence (IF) assays, detecting a substitute cell surface marker for RAQ, CDA4, CDB8, CD19, CD20, CD73 expression cells, FOXP3, FOXP3, CD163, IDO and PD-L1. The biopsy sections of the tumor were stained with hematoxylin and eosin (H&E) and evaluated for tissue quality and tumor identification. Immunofluorescence images were analyzed using image analysis software. The potential correlations with the results of the responses were assessed using statistical analysis based on univariate t tests, and the p values were bilateral, with no adjustment for multiplicity.
[001239] [001239] Individuals were assessed for response and safety results, including assessing tumor burden at various times after administration of RAQ T cells *, including three months after administration, and determining whether the individual had progressive disease (PD) stable disease (ED), partial response (PR) or complete response (CR). The safety outcomes assessed included neurotoxicity (neurological complications, including symptoms of confusion, aphasia, encephalopathy, myoclonic seizures, seizures, lethargy and / or altered mental status), graded on a scale of 1 to 5, according to the National Cancer Institute - Common Toxicity Criteria (CTCAE), version 4.03 (NCI-CTCAE v4.03). C. Results
[001240] [001240] The observed objective response rate (TRG; including CR and PR) was 71% (20/28) in the individuals for whom biopsies were assessed. Grade 1 and 2 SLC was observed in 36% (10/28; grade 1, 2) of the individuals for whom biopsies were evaluated, and NT grades 2-4 was observed in 18% (5/28) of the individuals for which biopsies were evaluated.
[001241] [001241] It was observed that pre-treatment tumor biopsies contained varied cellular compositions: tumor cells (median: 77%; range 5-96%), CD4 * cells (0.90%; 0.02-15%) and CD8 * cells (1.5%; 0-23%). The results showed that individuals with CR or PR at 3 months after the administration of RAQ * T cells had a higher percentage of endogenous CD4 * cells in pre-treatment tumors compared those with PD (CR, median PR: 7.9%; SD median: 0.38%; p <0.0001). The percentages of CD8 * cells in pre-treatment tumors did not differ between the three-month response groups (CR, median PR: 1.9%; median SD: 0.47%; p = 0.696).
[001242] [001242] In post-treatment biopsies, it was observed that RAQ * T cells infiltrated the tumor and constituted up to 22% of the cells in the biopsy sample. It was observed that the level of tumor infiltration in the post-treatment samples (7 to 20 days after administration) was higher in individuals who reached CR (median: 3.9%) or PR (median: 1.1%) in comparison to individuals who achieved the best global response (MRG) of DE or DP (median: 0.51%). Although CD4 * and CD8 * RAQ T cells have been observed to infiltrate the tumor area in the posttreatment period (7 to 20 days after administration), individuals who have reached CR have a higher CD8 T cell ratio * RAQ * for CD4 T cells * RAQ ”, in this post-treatment period, compared to individuals who achieved an ED or DP MRG (median of CR: 0.83; PD, median of PD: 0.14; p = 0.0097).
[001243] [001243] Comparing paired pre- and post-treatment biopsies of individuals, the results showed a trend towards individuals who finally obtained a CR or PR MRG, with a greater increase in the post-treatment of CD8 * cells (RAQ * T and not RAQ T) in tumors, compared to individuals who finally reached an MRG of ED or PD (CR, median change in PR: * 5.3%; PD, median change in DP: * 0.06%; p = 0.1225).
[001244] [001244] The expression of immunosuppressive factors, including CD73, FOXP3, CD163, IDO and PD-L1, varied between individuals in the pretreatment (CD73 (median: 1.5%; range 0-42%), FOXP3 (0 , 10%; 0-1.5%), IDO (0.06%; 0-11%), CD163 (1.2%; 0-24%) and PD-L1 (0.16%; 0-56 %)) and post-treatment (CD73 (1.6%; 0 -53%), FOXP3 (0.09%; 0-4.3%), IDO (0.28%; 0-15%), CD163 (3.6%; 0-22%) and PD-L1 (3.3%; 0-65%)). It was observed that post-treatment increases in CD8 * cells in the corresponding biopsies were associated with post-treatment increases in the expression of IDO (R2 = 0.64) and PD-L1 (R2 = 0.61). This result is consistent with the conclusion that the infiltration of CD8 * RAQ * cells at the time evaluated may indicate a potential probability of reaching a degree of response or duration of the response, and that the presence and / or activity of these cells may result in regulation positive effect of TME factors. D. Conclusion
[001245] [001245] A durable response in month 3 after administration of RAQ * T cells was observed to be associated with higher levels of CD4 * cells in pretreatment tumors. In post-treatment tumor cells, it was observed that RAQ ', CD4 * and CD8' * T cells infiltrated the tumor and adjacent tissue. RRO has been associated with an increase in RAQ * T cells on tumor biopsy. An increase in CD8 * levels in the post-treatment tumor biopsy compared to the CD8 * levels in the pre-treatment tumor biopsy was associated with increased expression of IDO and PD-L1. In some modalities, therapies targeting these pathways, such as those administered at the time or after the administration of RAQ-T cells, can improve one or more therapeutic results or their duration after administration of RAQ T cells *. Example 6: Additional Evaluation of Response and Sequencing Results in Individuals with Recurrent and Refractory Non-Hodgkin's Lymphoma After Administration of Anti-CD19 RAQ Expression Cells
[001246] [001246] Response and safety results were assessed in patients at a later time in the clinical study described in Examples 1 and 3 above. A. Individuals and Treatment
[001247] [001247] The analysis currently presented in this example is based on the evaluation of a total of 102 individuals in the COMPLETE cohort (73 in the CORE cohort) to whom anti-CD19 RAQ expression cells were administered. The COMPLETE cohort included individuals who had LDGCB (LDGCB, NOS again and transformed from follicular lymphoma; high-grade B cell lymphoma (doubleftriple hit); LDGCB transformed from CLL or MZL; LCBMP; and
[001248] [001248] At that time, a total of 134 individuals had been leucafesado, of which 2 had unavailable compositions. The product was available to 99% of the installed individuals (132/134) in the LDGCB cohort. Of the other 18 cts individuals were available, 5 withdrew and 13 developed progressive disease or died. 114 individuals in total anti-CD19 RAQ expression cells were administered, of which 12 received non-compliant antrCDIi9 RAQ expression cells (compositions that do not necessarily meet certain specifications, but are considered safe for administration). The subjects received ND1 (n = 45), double dose of ND1 (n = 6) or ND2 (n = 51). Seven (7) individuals with lining cell lymphoma (CSF) received RAQ * cells in ND1. At that time, eight (8) individuals were treated on an outpatient basis.
[001249] [001249] The demographic and baseline characteristics of individuals in the COMPLETE and MAIN cohort at the moment are shown in Table E18.
[001250] [001250] Table E19 shows the safety result of the COMPLETE and CORE cohorts. As shown, no deaths from SLC or NT were observed. In the COMPLETE cohort, the mean time of onset of SLC was 5 days (range, 2 to 12 days) and NT was 10 days
[001251] [001251] FIG. 29 describes the percentage of individuals in the COMPLETE cohort at this time (n = 102) who observed laboratory abnormalities and adverse treatment emergent events (TEAEs) (data for 6 individuals with LCM treated with product compliant with ND1 with at least not included 28 follow-up days; showing EAETs and laboratory abnormalities that occur in 20% or more of individuals).
[001252] [001252] As shown in Table E20, high response rates have been observed in individuals with relapsing or refractory LDGCB
[001253] [001253] The six-month objective response rates (TRG) among various subgroups of individuals in the low-risk LDGCB subgroups, which included all LDGCB patients treated at all dose levels in the CORE cohort, are shown in FIG. 30. The results showed high durable ORT in the low risk LDGCB subgroup for administration of anti-CD19 * RAQ T cells.
[001254] [001254] Results for duration of response (DOR, with an average follow-up of 8 months) and overall survival (grouped by the best overall response (non-responder, CR / PR, RC and / or RP), with an average follow-up of 12 months) are shown for the full cohort and the main cohort of individuals, in FIGS. 31A- 31D. The results showed that in the CORE cohort, 88% of individuals with CR at 3 months continued to have CR at 6 months, and 93% of individuals who had CR at 6 months continued to have a long-term response.
[001255] [001255] The results were consistent with an observation that administration of anti-CD19 RAQ * cell compositions containing an accurate and consistent dose of CD4 * and CD8 * RAQ "* cells results in a durable response in individuals with aggressive NHL R / R with poor prognosis and / or heavy pretreatment The results showed a favorable durable response rate in the CORE cohort, with 49% RRT and 46% CR at 6 months, and 93% of subjects (in all cases). dose levels) in CR at 6 months remained in response at this time.The results were also consistent with manageable toxicity and a favorable safety profile, including low rates of severe SLC (1%) and severe neurotoxicity (13%), which, in some aspects, favors outpatient administration.
[001256] [001256] The present invention is not intended to be limited in scope to the particular embodiments described, which are provided, for example, to illustrate various aspects of the invention. Several changes in the described compositions and methods will become apparent from the description and the teachings contained herein. Such variations can be practiced without departing from the true scope and spirit of the description and are intended to fall within the scope of the present description.
[001] [001] - [0014] GSGATNFSLLKQAGDVEENPGP [0015] P2A 8 | po [0017] ATNFSLLKQAGDVEENPGP | po [0020] QCTNYALLKLAGDVESNPGP E [0023] VKQTLNFDLLKLAGDVESNPGP [0024] F2A
[0032] [0032] gacatccagatgacccagaccacctecagectgage [0033] Sequence gcecagcectaggegacegggtgaccatcagectgcegggecagecag | company encoding gacatcagcaagtacctgaactagtatcagcagaagecegacgge | scFv accgtcaagctactgatctaccacaccagceggctacacageggeg tgcccagcceggtttageggcageggeteeggcacegactacagect gaccatctccaacctggaacaggaagatategcecacctacttttacca gcagggcaacacactgccctacacctttageggcggaacaaaget ggaaatcaccggcagcacetecggcageggcaagectaggeageg gcegagggcagcaccaagggegaggtgaagetgcaggaaagegg ccecetggeetaggtggeccecagecagagectgagegigacctigcace gtgagcggcgtgagcctgccegactacggegtgagetggateegge agcececeaggaagggectggaatagetagggcgatgatetaggagea gegagaccacctactacaacagegecetgaagageeggctgacea tcatcaaggacaacagcaagagccaggtatticctgaagatgaaca gectgcagacegacgacacegoecatetactactgcgccaageacta ctactacggcggcagctacgccatggactactggggecagggeace agcgtgaccgtgageage
[0034] [0034] X; PPX2P [0037] Articulate
[0035] [0035] X; is glycine, cysteine or arginine tion
[0036] [0036] X,> is cysteine or threonine 27 [0038] Glu Pro Lys Ser Cys Asp Lys Thr His [0039] Articulates Thr Cys Pro Pro Cys Pro tion
[0040] [0040] Glu Arg Lys Cys Cys Val Glu Cys Pro [0041] Articula Pro Cys Pro tion
[0042] [0042] ELKTPLGDTHTCPRCPEPKSCDTPPPC [0043] Articulates PRCPEPKSCDTPPPCPRCPEPKSCDTPPPCPRC | dog P
[0044] [0044] Glu Ser Lys Tyr Gly Pro Pro Cys Pro Ser [0045] Articulates Cys Pro tion
[0046] [0046] Glu Ser Lys Tyr Gly Pro Pro Cys Pro [0047] Articulation Cys Pro tion Tyr Gly Pro Pro Cys Pro Pro Cys Pro [0048] Articulation Lys Tyr Gly Pro Pro Cys Pro Cys Pro [0049] Articulation Glu Val Val Val Lys Tyr Gly Pro Cys Pro Pro [0050] Articulates Cys Pro tion RASQDISKYLN [0051] FMC63 CDR L1 SRLHSGV [0052] FMC63 CDR L2 37 GNTLPYTFG [0053] FMC63 CDR L3
DYGVS [0054] FMC63 CDR H1 VIWGSETTYYNSALKS [0055] FMC63 CDR H2 YAMDYWG [0056] FMC63 CDR H3 EVKLQESGPGLVAPSQSLSVTCTVSGVSLPDYGV | [0057] FMC63 SWIRQPPRKGLEWLGVIWGSETTYYNSALKSRLT | VH IIKDONSKSQVFLKMNSLQTDDTAIYYCAKHYYYGG
SYAMDYWGQGTSVTVSS DIQMTQTTSSLSASLGDRVTISCRASQDISKYLNW | - [0058] FMC63 YQQKPDGTVKLLIYHTSRLHSGVPSRFSGSGSGT | v. DYSLTISNLEQEDIATYFCQQGNTLPYTFGGGTKL
EIT 43 | DIQMTQTTSSLSASLGDRVTISCRASQDISKYLNW | - [0059] FMC63 YQQKPDGTVKLLIVHTSRLHSGVPSRFSGSGSGT | scFv DYSLTISNLEQEDIATYFCQQGNTLPYTFGGGTKL EITGSTSGSGKPGSGEGSTKGEVKLQESGPGLVA PSQSLSVTCTVSGVSLPDYGVSWIRQPPRKGLE WLGVIWGSETTYYNSALKSRLTIIKDNSKSQVFLK MNSLQTDDTAIYYCAKHYYYGGSYAMDYWGQGT
SVTVSS KASQNVGTNVA [0060] SJ25C1 CDRL1 SATYRNS [0061] SJ25C1 CDRL2 QQYNRYPYT [0062] SJ25C1 CDRL3 47 | SYWMN [0063] SJ25C1 CDR H1 QIYPGDGDTNYNGKFKG [0064] SJ25C1 CDR H2 KTISSVVDFYFDY [0065] SJ25C1 CDR H3 EVKLOQSGAELVRPGSSVKISCKASGYAFSSYW | [oo66] SJ25C1 MNWVKQRPGQGLEWIGQIYPGDGDTNYNGKFK | vH GQATLTADKSSSTAYMQLSGLTSEDSAVYFRAQK
TISSVVDFYFDYWGOGTTVTVSS DIELTASPKFMSTSVGDRVSVTCKASQNVGTNVA | “Foo67] SJ25C1 WYQQKPGAOSPKPLIYSATYRNSGVPDRFTGSGS | vL GTDFTLTITNVOSKDLADYFCQQYNRYPYTSGGG
TKLEIKR | 52 | GGCESCEGESEGEGS [0068] Ligand
EVKLQQSGAELVRPGSSVKISCKASGYAFSSYW [0069] SJ25C1 MNWVKQRPGQGLEWIGQIYPGDGDTNYNGKFK | scFv GQATLTADKSSSTAYMQLSGLTSEDSAVYFRAQK TISSVVDFYFDYWGQGTTVTVSSGGGESGGGES GGGGSDIELTASPKFMSTSVGDRVSVTCKASQN VGTNVAWYQQKPGQSPKPLIYSATYRNSGVPDR FTGSGSGTDFTLTITNVOSKDLADYFCQQYNRYP
YTSGGGTKLEIKR HYYYGGSYAMDY [0070] FMC63 HC-CDR3 HTSRLHS [0071] FMC63 LC-CDR2 QQGNTLPYT [0072] FMC63 LC-CDR3 ACACGGCCTCGTGTATTACTGT [0073] Initiator IGGGT

权利要求:
Claims (158)
[1]
1. Method for treating an individual with or suspected of a disease or condition, the method characterized by the fact that it comprises administering to the individual a dose of CD4 * and CD8 * T cells, each of the CD4 * and CD8 * T cells individually , comprising a receptor that specifically binds to a target antigen expressed by the disease or condition or a cell or tissue therein and / or that is associated with the disease or condition, wherein administration - comprises - administering “a plurality of separate compositions, the plurality of separate compositions comprising a first composition comprising one of the CD4 * T cells and CD8 * T cells and a second composition comprising the other of the CD4 * T cells and CD8 * T cells.
[2]
2. Method according to claim 1, characterized in that the receptor comprised of CD4 * T cells and / or the receptor comprised of CD8 * T cells comprises a recombinant receptor that is the same and / or in which the cells CD4 * T and / or CD8 * T cells are genetically modified to express an equal recombinant receptor.
[3]
3. Method, according to claim 1 or 2, characterized by the fact that: the administration of the first composition and the administration of the second composition are carried out on the same day, they are carried out between about 0 and about 12 hours of band, between about 0 and about 6 hours of band or between about 0 and 2 hours of band; or the initiation of administration of the first composition and initiation of administration of the second composition are carried out between about 1 minute and about 1 hour of band or between about 5 minutes and about 30 minutes of band.
[4]
4. Method according to any of the claims
1 to 3, characterized by the fact that the first composition and the second composition are administered no more than 2 hours, no more than 1 hour, no more than 30 minutes, no more than 15 minutes, no more than 10 minutes or not more than 5 minutes of track.
[5]
Method according to any one of claims 1 to 4, characterized in that the first composition comprises CD4 * T cells.
[6]
Method according to any one of claims 1 to 4, characterized in that the first composition comprises CD8 * T cells.
[7]
Method according to any one of claims 1 to 6, characterized in that the start of administration of the first composition is carried out before the start of administration of the second composition.
[8]
Method according to any one of claims 1 to 7, characterized in that: the dose of CD4 * and CD8 * T cells comprises a defined proportion of CD4 * cells that express a recombinant receptor to CD8 * cells that express a recombinant and / or CD4 * cell receptor for CD8 * cells, which is either approximately 1: 1 or between approximately 1: 3 and approximately 3: 1; and / or CD4 * T cells comprising the receptor in one of the first and second compositions and CD8 * T cells comprising the receptor in another of the first and second compositions are present in a defined ratio which is either approximately 1: 1 or is between approximately 1: 3 and approximately 3: 1; and / or CD4 * T cells comprising the receptor and CD8 * T cells comprising the receptor administered in the first and second compositions are present in a defined ratio, the ratio of which is either approximately 1: 1 or between approximately 1: 3 and approximately 3: 1.
[9]
9. Method according to claim 8, characterized by the fact that the defined ratio is or is approximately 1: 1.
[10]
Method according to any one of claims 1 to 9, characterized in that the dose of CD4 * and CD8 * T cells comprises: between approximately 5 x 107 and the or about 1 x 108 T cells of expression of total recombinant receptor, inclusive; between or about 1 x 107 and the or about 2 x 10 th total recombinant receptor expression T cells, inclusive; between or about 5 x 10 7 and at or about 1.5 x 10 10 total recombinant receptor expression T cells; a or about 5 x 10 7 total recombinant receptor expression T cells; or at or about 1 x 10 10 total recombinant receptor expression T cells; or about 1.5 x 10 10 total recombinant receptor expression T cells.
[11]
11. Method according to any one of claims 1 to 10, characterized in that the dose of CD4 * and CD8 * T cells comprises: between or about 5 x 10º and at or about 1 x 108 CD8 T cells * recombinant receptor expression, inclusive; between or about 1 x 107 and at or about 0.75 x 10 th CD8 * T cells of recombinant receptor expression, inclusive; to about 2.5 x 10 7 CD8 * T cells that express recombinant receptor; in about 5 x 107 ”CD8 * T cells that express recombinant receptor; or at or about 0.75 x 10 th CD8 * T cells of recombinant receptor expression.
[12]
Method according to any one of claims 1 to 11, characterized in that the recombinant receptor specifically binds to an antigen associated with the disease or condition or expressed in cells of the environment of an injury associated with the disease or condition.
[13]
13. Method according to any one of claims 1 to 12, characterized by the fact that the disease or condition is a cancer.
[14]
14. Method according to any of claims 1 to 13, characterized by the fact that the disease or condition is a myeloma, leukemia or lymphoma.
[15]
15. Method according to any one of claims 1 to 14, characterized by the fact that the antigen is CD19.
[16]
16. Method according to any one of claims 1 to 15, characterized in that the disease or condition is a B cell neoplasia and / or is acute lymphoblastic leukemia (ALL), adult ALL, chronic lymphoblastic leukemia (LLC ), non-Hodgkin's lymphoma (NHL) and diffuse large B-cell lymphoma (LDGCB).
[17]
17. Method according to any one of claims 1 to 16, characterized in that the recombinant receptor is a chimeric antigen (RAQ) receptor.
[18]
18. Method according to claim 17, characterized in that the RAQ comprises an extracellular antigen recognition domain that specifically binds to the antigen and an intracellular signaling domain comprising a CD3-zeta (CD36) chain and a region co-stimulating signaling domain which is a CD28 or 4-1BB signaling domain.
[19]
19. Method according to any one of claims 1 to 18, characterized in that the T cells are primary T cells obtained from an individual.
[20]
20. Method according to any one of claims 1 to 19, characterized in that the T cells are autologous to the individual.
[21]
21. Article of manufacture, characterized by the fact that it comprises (1) a vial containing a composition comprising a plurality of CD4 * T cells expressing a recombinant receptor and (2) instructions for administration, to an individual with a disease or condition: a unit dose of cells of the composition, the unit dose comprising all or a portion of the plurality of CD4 * T cells and a unit dose of a composition comprising CD8 * T cells expressing a recombinant receptor, in which the vial does not comprise the unit dose of the composition comprising CD8 * T cells that express the recombinant receptor.
[22]
22. Article of manufacture, characterized by the fact that it comprises (1) a vial containing a composition comprising a plurality of CD8 * T cells expressing a recombinant receptor and (2) instructions for administering, to an individual with a disease or condition: a unit dose of cells of the composition, the unit dose comprising all or a portion of the plurality of CD8 * T cells and a unit dose of a composition comprising CD4 * T cells expressing a recombinant receptor, where the vial does not comprises the unit dose of the composition comprising CD4 * T cells that express the recombinant receptor.
[23]
23. The article of manufacture according to claim 21 or 22, characterized by the fact that: the recombinant receptor expressed by CD4 * cells and the recombinant receptor expressed by CD8 * T cells are the same; the recombinant receptor expressed by CD4 * cells and the recombinant receptor expressed by CD8 * T cells are different; or the recombinant receptor expressed by CD4 * cells and the recombinant receptor expressed by CD8 * T cells bind to the same antigen, which is expressed by or associated with the disease or condition or cell or tissue thereof.
[24]
24. Article of manufacture according to any one of claims 21 to 23, characterized by the fact that the vial comprises greater or greater than about 10 x 10 T cells or T cells of recombinant receptor expression, greater or greater than than about 15 x 10 th T cells or recombinant T cells that express receptors, greater or greater than about 25 x 10 th T cells or T cells of recombinant receptor expression.
[25]
25. Article of manufacture according to any one of claims 21 to 24, characterized by the fact that the vial comprises between about 10 million cells per ml and about 70 million cells per ml, between about 10 million cells cells per ml and about 50 million cells per ml, between about 10 million cells per ml and about 25 million cells per ml, between about 10 million cells per ml and about 15 million cells per ml , 15 million cells per ml and about 70 million cells per ml, between about 15 million cells per ml and about 50 million cells per ml, between about 15 million cells per ml and about 25 million cells per ml, between about 25 million cells per ml and about 70 million cells per ml, between about 25 million cells per ml and about 50 million cells per ml and between about 50 million cells per ml and about 70 million cells per ml.
[26]
26. Article of manufacture according to any one of claims 21 to 25, characterized in that the composition further comprises a cryoprotectant and / or the article further includes instructions for defrosting the composition prior to administration to the individual.
[27]
27. Article of manufacture according to any one of claims 21 to 26, characterized by the fact that the recombinant receptor is a chimeric antigen receptor.
[28]
28. Method of treating an individual with or with suspected non-Hodgkin's lymphoma (NHL), the method characterized by the fact that it comprises administering to the individual a dose of T cells comprising T cells that express a chimeric antigen receptor ( RAQ) that specifically binds to a target antigen expressed by NHL, where: the dose of T cells comprises between about 2.5 x 10º T cells of RAQ expression and 2 x 10º T cells of RAQ expression, inclusive; and NHL, comprises diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP), NOS (again or transformed from indolent lymphoma) or Grade 3B follicular lymphoma and in which the individual is or has been identified as having an Eastern Cooperative Oncology Group Performance Status (ECOG) of O or 1.
[29]
29. Method according to claim 28, characterized in that the dose of T cells comprises a defined ratio of CD4 * cells that express RAQ and CD8 * cells that express RAQ and / or CD4 * cells for cells CD8 *,
whose ratio is approximately 1: 1 or between approximately 1: 3 and approximately 3: 1.
[30]
30. Method of treating an individual with non-Hodgkin's lymphoma (NHL), the method characterized by the fact that it comprises administering to the individual a dose of T cells comprising T cells that express a chimeric antigen (RAQ) receptor that is specifically binds to a target antigen expressed by NHL, the dose of T cells comprising a defined ratio of CD4 * cells that express RAQ and CD8 * cells that express RAQ and / or CD4 + cells to CD8 * cells, the ratio of which is approximately or is 1: 1, where NHL comprises diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP), NOS (again or transformed from indolent lymphoma) or Grade 3B follicular lymphoma.
[31]
31. Method according to claim 30, characterized by the fact that the individual is or has been identified as having an ECOG status of O or 1.
[32]
32. Method according to any one of claims 28 to 31, characterized by the fact that: at least 35%, at least 40% or at least 50% of the individuals treated according to the method achieve a complete response (RC) ; at least 60%, 70%, 80%, 90% or 95% of individuals who achieve a CR exhibit a durable CR for at least 3 months or for 6 months; and / or at least 60%, 70%, 80%, 90% or 95% of individuals who achieve CR in one month and / or in three months remain in response, remain in CR and / or survive or survive without progression, for at least or greater than 3 months and / or greater than or equal to 6 months and / or greater than 9 months after the performance of the CR; and / or at least 50%, at least 60% or at least 70% of the individuals treated according to the method achieve an objective response (RO); at least 60%, 70%, 80%, 90% or 95% of individuals who obtain an OR exhibit an OR that is durable for more than 3 months or for more than 6 months; and / or at least 35%, at least 40% or at least 50% of individuals who obtain an OR remain in response or survive for at least 3 months and / or for more than 6 months after surgery; and / or at least 40%, at least 50%, at least 60%, at least 70% of the individuals who, at or before the dose of the cells, had or were identified as having a double or triple occurrence lymphoma or relapse, after the administration of an autologous stem cell transplant (TACT), obtained an OR or a durable RO for more than 3 months or for more than 6 months.
[33]
33. Method according to any one of claims 28 to 32, characterized in that the cells are autologous to the individual and a minimum absolute lymphocyte count (CLA) is not necessary for apheresis and / or specified for the production of therapy ; and / or cells are produced by a process that, for at least 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% of individuals with the disease or condition or the selected population of individuals, is capable of generating a cellular product for administration according to the method.
[34]
34. Method according to any one of claims 28 to 33, characterized by the fact that: greater than or greater than about 50%, about 60%, about 70% or about 80% of the individuals treated according to with the method do not exhibit a cytokine release syndrome (SLC) grade 3 or higher and / or do not exhibit neurotoxicity grade 3 or higher and / or greater than 40% or 50% or 55% do not exhibit neurotoxicity or SLC.
[35]
35. Method of treating an individual with non-Hodgkin's lymphoma (NHL), the method characterized by the fact that it comprises administering to the individual a dose of T cells comprising T cells that express a chimeric antigen (RAQ) receptor that is specifically binds to a target antigen expressed by NHL, where: the dose of T cells comprises between about 5 x 107 T cells of recombinant receptor expression and 1 x 10 T cells of recombinant receptor expression, including said dose comprising a defined ratio of CD4 * cells that express the recombinant receptor to CD8 * cells that express the recombinant receptor and / or CD4 * cells to CD8 * cells, the ratio of which is approximately or is 1: 1; and the method results in ( 1) a complete response (CR) in at least 35%, at least 40% or at least 50% of the treated individuals and / or objective response (RO) in at least 50%, at least 60% or at least 70% of the treated individuals and (2) results in not more than 50% of individuals exhibiting a cytokine release syndrome (SLC) greater than grade 2 and / or neurotoxicity greater than grade 2.
[36]
36. Method according to claim 35, characterized by the fact that at least 40%, at least 50%, at least 60%, at least 70% of the individuals who, at or before the administration of the cell dose, had or were identified as having a double or triple lymphoma occurring or relapsing after administration of an autologous stem cell transplant (TACT), achieved an OR or a durable RO for more than 3 months or for more than 6 months.
[37]
37. Method according to claim 35 or 36, characterized by the fact that: the RC or RO is durable for more than 3 months or more than 6 months; and / or at least 20%, at least 25%, at least 35%, at least 40% or at least 50% of the individuals treated according to the method achieve a durable CR for more than 3 months or for more than 6 months ; and / or at least 60%, 70%, 80%, 90% or 95% of individuals treated with the method and who reach CR, remain in CR or remain in response or remain surviving for at least 3 months or at least 6 months or equal to or greater than 9 months; and / or at least 60%, 70%, 80%, 90% or 95% of individuals treated with the method who achieve CR for one month and / or for three months remain in response, remain in CR and / or survive or survive without progression, for more than 3 months and / or for more than 6 months and / or for more than 9 months; and / or at least 50%, at least 60% or at least 70% of the individuals treated according to the method achieve an objective response (RO); at least 60%, 70%, 80%, 90% or 95% of individuals obtain an RO that is durable for at least 3 months or at least 6 months; and / or at least 35%, at least 40% or at least 50% of the individuals treated with the method and reaching an RO remain in response or survive for at least 3 months and / or at least 6 months.
[38]
38. Method according to any of claims 28 to 37, characterized by the fact that: upon administration or before the dose of cells, the individual is or has been identified as having an associated lymphoma or involving the involvement of the central nervous system ( SNC); and / or at least 70%, at least 80%, at least 90% or at least 95% of the subjects treated according to the method that, on or before administration of the displayed cell dose or has been identified as exhibiting a lymphoma with CNS involvement, achieved a resolution of CNS disease.
[39]
39. Method of treatment of an individual, the method characterized by the fact that it comprises administration to an individual who has lymphoma, a dose of T cells comprising T cells that express a chimeric antigen receptor (RAQ) that specifically binds to a target antigen expressed by lymphoma, in which the individual's lymphoma is associated with or involves central nervous system (CNS) involvement.
[40]
40. Method according to claim 38 or 39, characterized in that, at the time or before the administration of the cell dose, the individual comprises a brain injury, optionally a brain injury to the temporal lobe.
[41]
41. Method according to claim 39 or 40, characterized by the fact that lymphoma is a B cell malignancy.
[42]
42. Method according to any one of claims 39 to 41, characterized in that the lymphoma is a non-Hodgkin's lymphoma (NHL).
[43]
43. Method according to any one of claims 38 to 42, characterized by the fact that: at least 35%, at least 40% or at least 50% of the individuals treated according to the method achieve a complete response (RC) or remission of CNS disease; at least 60%, 70%, 80%, 90% or 95% of individuals who achieve CR remain in CR for a period of 3 months or more or 6 months or more; and / or at least 60%, 70%, 80%, 90% or 95% of individuals who achieve CR or remission of CNS disease in one month and / or in three months remain in response, remain in CR and / or survive or survive without progression, for more than 3 months and / or for more than 6 months and / or for more than 9 months; and / or at least 50%, at least 60% or at least 70% of the individuals treated according to the method achieve objective response (RO) or remission of the CNS disease; at least 60%, 70%, 80%, 90% or 95% of individuals who obtain CR, for a period of 3 months or more or more than 6 months; and / or at least 60%, 70%, 80%, 90% or 95% of individuals who achieve OR or remission of CNS disease remain in response or survive for at least 3 months and / or at least 6 months; and / or the brain injury is reduced in size or volume by greater or greater than about 25%, 50%, 75% or more; and / or the reduction or remission or clearance of CNS disease is achieved in at least 35%, at least 40% or at least 50% of individuals treated according to the method.
[44]
44. Method according to any of claims 28 to 43, characterized by the fact that:
greater or greater than about 30%, 35%, 40% or 50% of the individuals treated according to the method do not exhibit any degree of cytokine release syndrome (SLC) or neurotoxicity; and / or at least about 45%, 50%, 60%, 65%, 70%, 75%, 80%, 85%, 90% or 95% of the individuals treated according to the method do not present SLC onset before 3 days after the start of administration and / or have no neurotoxicity before 5 days after the start of administration; and / or median onset of neurotoxicity among subjects treated according to the method is equal to or after the mean peak or mean time to resolution of the SLC in subjects treated according to the method and / or median onset of neurotoxicity between subjects. subjects treated according to the method is greater than or about 8, 9, 10 or 11 days.
[45]
45. Method according to any of claims 28 to 44, characterized by the fact that prior to the start of the cell dose administration, the individual did not receive an agent or treatment capable of treating, preventing, delaying, reducing or attenuating the development or risk of developing toxicity after administration of the cell dose; and / or
[46]
46. Method according to claim 45, characterized in that the agent is or comprises an anti-IL-6 antibody, anti-IL-6R antibody or a steroid.
[47]
47. Method according to claim 45 or 46, characterized in that the agent is or comprises tocilizumab, siltuximab or dexamethasone.
[48]
48. Method, according to any of claims 28 to 47, characterized by the fact that: administration and any follow-up are performed on an outpatient basis and / or without the need for admission or overnight in a hospital; and if the individual has a prolonged fever or fever that has been reduced or not reduced by more than 1 ºC after treatment with antipyretic, the patient is admitted to the hospital or overnight in the hospital and / or administered an agent or treatment for the treatment or preventing or reducing or mitigating a neurotoxicity and / or cytokine release syndrome or risk of it.
[49]
49. Method according to any one of claims 28 to 38 and 42 to 48, characterized by the fact that NHL is selected from the group consisting of aggressive NHL, diffuse large B cell lymphoma (LDGCB), NOS (again and transformed from indolent), primary mediastinal B-cell lymphoma (LCBMP), lining cell lymphoma (CSF) and / or follicular lymphoma (LF), optionally Grade 3B follicular lymphoma (LF3B).
[50]
50. Method according to any one of claims 28 to 38 and 42 to 49, characterized by the fact that NHL comprises diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP), NOS ( again or transformed from indolent lymphoma), or Grade 3B follicular lymphoma.
[51]
51. Method according to any one of claims 28 to 38 and 42 to 50, characterized by the fact that the NHL comprises LDGCB.
[52]
52. Method according to claim 51, characterized by the fact that the LDGCB does not comprise LDGCB transformed from LZM and CLL (Richter) and / or the individual administered the cell dose has an LDGCB characterized as newly or transformed from indolent and / or does not comprise an LDGCB transformed from LZM and CLL.
[53]
53. Method according to any one of claims 28 to 38 and 42 to 52, characterized in that the NHL does not comprise LCBMP and / or the individual administered the cell dose does not comprise LCBMP.
[54]
54. Method according to any of claims 35 to 53, characterized by the fact that the individual is or has been identified as having an Eastern Cooperative Oncology Group Performance Status (ECOG) of 0, 1 or 2.
[55]
55. Method according to any of claims 28 to 54, characterized in that the individual is or has been identified as having an ECOG status of 0 or 1.
[56]
56. Method according to any of claims 28 to 55, characterized in that, at the time or immediately before the administration of the cell dose, the individual relapsed after remission after treatment with, or became refractory to, one or more more previous therapies for NHL, optionally one, two or three previous therapies other than another dose of RAQ expression cells.
[57]
57. Method according to any one of claims 28 to 56, characterized by the fact that, on or before the administration of the cell dose: the individual is or has been identified as having a doubler / triple hit lymphoma; and / or the individual is or has been identified as having a chemo-refractory lymphoma, optionally a chemo-refractory LDGCB; and / or the individual did not achieve complete remission (CR) in response to previous therapy; and / or the individual relapsed within 1 year or less than 1 year after receiving an autologous stem cell transplant (TACT).
[58]
58. Method according to any one of claims 28 to 57, characterized in that it comprises, prior to the administration of the cell dose, identifying or selecting an individual for the administration of the cell dose he has: a doublertriple hit lymphoma; a chemoreceptive lymphoma, optionally a chemoreceptive LDGCB; did not achieve complete remission (CR) in response to previous therapy for the treatment of malignancy, optionally NHL; and / or relapsed within 1 year or less than 1 year after receiving an autologous stem cell transplant (TACT); and / or has a lymphoma associated with or involving the involvement of the central nervous system (CNS).
[59]
59. The method of any one of claims 28 to 58, characterized in that it further comprises administering to the individual an additional therapeutic agent or therapy, optionally different from cell therapy, optionally different from RAQ * T cell therapy.
[60]
60. Method according to any one of claims 28 to 59, characterized in that: the RAQ comprises an antigen-specific scFv, a transmembrane domain, a cytoplasmic signaling domain derived from a costimulatory molecule, which is optionally or comprises a 4-1BB, and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which optionally is or comprises a CD3zeta signaling domain and optionally further comprises a spacer between the transmembrane domain and the scFv; the RAQ comprises, in order, an antigen-specific scFv, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulatory molecule, which optionally is or comprises a 4-1BB signaling domain and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which optionally is a CD3zeta signaling domain; or the RAQ comprises, in order, an antigen-specific scFv, a spacer, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulating molecule, which optionally is a 4-1BB signaling domain, and a cytoplasmic signaling domain derived from a primary signaling ITAM-containing molecule, which optionally is or comprises a CD3zeta signaling domain; and where:
the spacer is a polypeptide spacer that (a) comprises or consists of all or a portion of an immunoglobulin joint or a modified version thereof or comprises about 15 amino acids or less and does not comprise an extracellular region of CD28 or an extracellular region of CD8, (b) comprises or consists of all or a portion of an immunoglobulin joint, optionally an IgG4 joint, or a modified version of it and / or comprises about amino acids or less, and does not comprise an extracellular region of CD28 or an extracellular region of CD8, or (c) is 12 or approximately amino acids in length and / or comprises or consists of all or a portion of an immunoglobulin joint, optionally an IgG4 or a modified version thereof; or (d) has or consists of the sequence of SEQ ID NO: 1, a sequence encoded by SEQ ID NO: 2, SEQ ID NO: 30, SEQ ID NO: 31, SEQ ID NO: 31, SEQ ID NO: 32, SEQ ID NO: 33, SEQ ID O: N 34, or a variant of any of the previous items having at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93% , 94%, 95%, 96%, 97%, 98%, 99% or more of sequence identity, or (e) comprises or consists of the formula XIPPX2P, where X1 is glycine, cysteine or arginine and X2 is cysteine or threonine; and / or the co-stimulatory domain comprises SEQ ID NO: 12 or a variant thereof with at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94% , 95%, 96%, 97%, 98%, 99% or more of sequence identity; and / or the primary signaling domain comprises SEQ ID NO: 13 or 14 or 15 with at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94 %, 95%, 96%, 97%, 98%, 99% or more of sequence identity; and / or scFfv comprises a CDRL1 sequence of RASQDISKYLN (SEQ ID NO: 35), a CDRL2 sequence of SRLHSGV (SEQ ID NO: 36) and / or a CDRL3 sequence of GNTLPYTFG (SEQ ID NO: 37) and / or a DYGVS CDRH1 sequence (SEQ ID NO: 38) a VIWGSETTYYNSALKS CDRH2 sequence (SEQ ID NO: 39) and / or a YAMDYWG CDRH3 sequence (SEQ ID NO: 40) or where the scFv comprises a variable region of the FMC63 heavy chain and a variable region of the FMC63 light chain and / or a CDRL1 sequence of FMC63, a sequence of CDRL2 of FMC63, a sequence of CDRL3 of FMC63, a sequence of CDRH1 of FMC63, a sequence of CDRH2 of FMC63 and a sequence of CDRH3 of FMC63 either binds to the same epitope that either competes for binding with any of the above, and optionally where scFv comprises, in order, a VH, a linker, optionally comprising SEQ ID NO : 24, and a VL, and / or scFv comprises a flexible linker and / or comprises the amino acid sequence established as SEQ ID N O: 24.
[61]
61. Method according to any one of claims 28 to 60, characterized in that the antigen is a B cell antigen, which is optionally CD19.
[62]
62. Method according to any one of claims 1 to 20 and 28 to 61, characterized by the fact that, prior to administration, the subject was preconditioned with a lymphodeplective therapy comprising the administration of fludarabine and / or cyclophosphamide.
[63]
63. Method according to any one of claims 1 to 20 and 28 to 62, characterized in that it further comprises, immediately before administration, the administration of a therapy that complicates the lymphodes to the individual, which comprises the administration of fludarabine and / or cyclophosphamide.
[64]
64. Method, according to claim 63, characterized by the fact that: the administration of the cell dose and / or lymphodeplet therapy is performed via ambulatory release; and if the individual has a prolonged fever or fever that has been reduced or not reduced by more than 1 ºC after treatment with antipyretic, the patient is admitted to the hospital or overnight in the hospital and / or administered an agent or treatment for the treatment or preventing or reducing or mitigating a neurotoxicity and / or cytokine release syndrome or risk of it.
[65]
65. Method according to any one of claims 28 to 64, characterized in that the cell dose is administered parenterally, optionally intravenously.
[66]
66. Method according to any one of claims 28 to 65, characterized in that the T cells are primary T cells obtained from an individual.
[67]
67. Method according to any one of claims 28 to 66, characterized in that the T cells are autologous to the individual.
[68]
68. Method according to any one of claims 28 to 67, characterized in that the dose of T cells comprises CD4 * T cells that express RAQ and CD8 * cells that express RAQ and the administration comprises administering - separately - a first composition comprising one of the CD4 * T cells and CD8 * T cells and a second composition comprising the other of the CD4 * T cells or CD8 * T cells.
[69]
69. Method, according to claim 68, characterized by the fact that: the first composition and the second composition are administered with a range of 0 to 12 hours, a range of 0 to 6 hours or range of 0 to 2 hours or in which administration of the first composition and administration of the second composition are carried out on the same day, are carried out between about 0 and about 12 hours of band, between about 0 and between about 0 and 2 hours of band; and / or the initiation of administration of the first composition and the initiation of administration of the second composition are carried out between about 1 minute and about 1 hour of band or between about 5 minutes and about 30 minutes of band.
[70]
70. Method according to claim 67 or 68, characterized in that the first composition and the second composition are administered no more than 2 hours, no more than 1 hour, no more than 30 minutes, no more than 15 minutes, no more than 10 minutes or no more than 5 minutes of track.
[71]
71. Method according to any one of claims 67 to 70, characterized in that the first composition comprises CD4 * T cells.
[72]
72. Method according to any one of claims 67 to 71, characterized in that the first composition comprises CD8 * T cells.
[73]
73. Method according to any one of claims 67 to 72, characterized in that the first composition is administered before the second composition.
[74]
74. Method for assessing the likelihood of a response to cell therapy, characterized by the fact that the method comprises: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample, where the one or more analyzed is selected from ferritin, LDH, CXCL10, G-CSF and I1L-10, in which: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of cells genetically modified proteins that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) individually compare the level, quantity or concentration of the analyzed in the sample with a threshold level, thus determining the probability that an individual will achieve a response to cell therapy.
[75]
75. The method of claim 74, characterized by the fact that it further comprises administering cell therapy to the individual if the individual is likely to obtain a response.
[76]
76. Method for selecting an individual for treatment, characterized by the fact that the method comprises: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample, in which the one or more analyzed is selected from of ferritin, LDH, CXCL10, G-CSF and IL-10, in which: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a receptor recombinant; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) selecting an individual who is likely to respond to treatment based on the results of determining the likelihood of an individual obtaining a response to cell therapy by individually comparing the level, quantity or concentration of the analyzed in the sample to a threshold level.
[77]
77. Method according to claim 76, characterized by the fact that it further comprises the administration of cell therapy to the individual selected for treatment.
[78]
78. Treatment method, the method characterized by the fact that it comprises: (a) selecting an individual who is likely to respond to treatment with cell therapy based on the results of determining the likelihood that an individual will obtain a response to cell therapy by comparing, individually , the level, quantity or concentration of one or more analyzed in a biological sample, in which the one or more analyzed is selected from ferritin, LDH, CXCL10, G-CSF and IL-10, at a threshold level, where : the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) administering cell therapy to an individual selected for treatment.
[79]
79. Method according to any one of claims 74 to 78, characterized by the fact that: the individual is likely to obtain a response if the level, quantity or concentration of one or more analyzed is below a threshold level and the individual you probably will not get an answer if the level, quantity or concentration of one or more of the analyzed is above a threshold level.
[80]
80. Method according to any one of claims 74 to 79, characterized in that the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and / or is within a standard deviation below the median or average level, quantity or concentration, or is or is above the median or average level, quantity or concentration, of the analyzed in a biological sample obtained from a group of individuals before receiving therapy cell, in which each individual in the group continued to obtain a response after administration of a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[81]
81. Method according to any of claims 74 to 79, characterized in that the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and / or is within a standard deviation above the median or average level, amount or concentration of the analyzed in a biological sample obtained from a group of individuals before receiving a cell therapy, in which each of the individuals in the group was, will exhibit stable disease ( DE) and / or progressive disease (PD) after administration of a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[82]
82. Method according to any of claims 74 to 81, characterized in that the answer comprises an objective answer.
[83]
83. Method, according to claim 82, characterized by the fact that the objective response comprises complete response (RC) or partial response (RP).
[84]
84. Method for assessing the likelihood of a durable response to cell therapy, characterized by the fact that the method comprises: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample, where the one or more most analyzed is selected from LDH, ferritin, CRP, D-dimer, SAA-1, IL-6, II-10, IL-15, IL-16, TNF-a, IFN-y, MIP-10, CXCL-10, IL-8, MCP-1 and MIP-18, wherein: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) individually compare the level, quantity or concentration of the analyzed in the sample with a threshold level, thus determining the probability that an individual will achieve a lasting response to cell therapy.
[85]
85. Method according to claim 84, characterized in that it further comprises administering cell therapy to the individual if the individual is likely to obtain a response.
[86]
86. Method for selecting an individual for treatment, characterized by the fact that the method comprises: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample, in which the one or more analyzed is selected from among LDH , ferritin, CRP, D-dimer, SAA-1, IL-6, IL-10, IL-15, IL-16, TNF-a, IFN-y, MIP-10, CXCL-10, I1L-8, MCP- 1 and MIP-18, wherein: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) selecting an individual who is likely to respond to treatment based on the results of determining the likelihood that an individual will obtain a durable response to cell therapy by individually comparing the level, quantity or concentration of the analyzed in the sample to a threshold level.
[87]
87. Method according to claim 86, characterized by the fact that it further comprises the administration of cell therapy to the individual selected for treatment.
[88]
88. Treatment method, characterized by the fact that the method comprises: (a) selecting an individual who is likely to respond to treatment with cell therapy based on the results of determining the likelihood that an individual will obtain a durable response to cell therapy by comparing, individually, the level, quantity or concentration of one or more analyzed in a biological sample up to a threshold level, in which the one or more analyzed is selected from LDH, ferritin, CRP, D-dimer, SAA-1, IL-6, IL - 10, IL-15, IL-16, TNF-a, IFN-y, MIP-10, CXCL-10, IL-8, MCP-1 and MIP-13, where: the biological sample is from an individual who is a candidate for treatment with cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) administering cell therapy to an individual selected for treatment.
[89]
89. Method according to any one of claims 85 to 88, characterized by the fact that: the individual is likely to obtain a durable response if the level, quantity or concentration of one or more analyzed is below a threshold level and the individual is unlikely to achieve a lasting response if the level, amount or concentration of one or more of the subject is above a threshold level.
[90]
90. Method according to any of claims 85 to 88, characterized in that the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and / or is within a standard deviation below the median or average level, quantity or concentration, or is or is above the median or average level, quantity or concentration, of the analyzed in a biological sample obtained from a group of individuals before receiving therapy cell, in which each individual in the group continued to achieve a lasting response after administration of a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[91]
91. Method according to any of claims 85 to 88, characterized by the fact that the threshold level is within 25%, within 20%, within 15%, within 11% or within 5% and / or is within a standard deviation above the median or average level, quantity or concentration of analyzed in a biological sample obtained from a group of individuals before receiving cell therapy, in which each individual in the group did not obtain a durable response after administering a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[92]
92. Method according to any one of claims 85 to 91, characterized in that the durable response comprises a complete response (RC) or partial response (RP) that is durable for at least 3 months, 4 months, 5 months or 6 months.
[93]
93. Method according to any of claims 85 to 92, characterized in that the durable response comprises an RC or RP that is durable for at least 3 months.
[94]
94. Method for assessing the risk of developing toxicity after administration of cell therapy, characterized by the fact that the method comprises: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample from an individual or a volumetric measure of tumor burden in an individual, in which the one or more analyzed is selected from LDH, ferritin, C-reactive protein (CRP), D-dimer (fibrin degradation product), IL-6, IL- 8, IL-10, IL-15, IL-16 TNF-a, IFN-a2, MCP-1, MIP-10a and MIP-168, in which: the individual is a candidate for treatment with cell therapy, comprising the said cell therapy optionally a dose or composition of genetically modified cells expressing a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) individually compare the level, quantity or concentration of the analyzed in the sample or the volumetric measure of the tumor load with a threshold level, thus determining the risk of developing toxicity after the administration of cell therapy.
[95]
95. Method for identifying an individual, characterized by the fact that the method comprises: (a) assessing the level, quantity or concentration of one or more analyzed in a biological sample from an individual or a volumetric measure of the tumor burden in an individual, where the one or more analyzed is selected from LDH, ferritin, C-reactive protein (PCR), D-dimer (fibrin degradation product), IL-6, IL-8, IL-10, I1L-15, IL -16 TNF-a, IFN-02, MCP-1, MIP-1a and MIP-18B, in which: the individual is a candidate for treatment with cell therapy, said cell therapy optionally comprising a dose or composition of cells genetically modified proteins that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and (b) identify an individual who is at risk of developing toxicity after administering cell therapy based on comparing, individually, the level, quantity or concentration of the analyzed in the sample or the volume measurement of the tumor load at a threshold level .
[96]
96. Treatment method, characterized by the fact that it comprises: assessing the level, quantity or concentration of one or more analyzed in a biological sample of an individual or a volumetric measure of tumor load in the individual, in which the one or more analyzed is selected from LDH, Ferritin, C-reactive protein (CRP), D-dimer (fibrin degradation product), IL-6, IL-8, IL-10, IL-15, IL-16 TNF-a, IFN- a2, MCP-1, MIP-10a and MIP-168, wherein: the individual is a candidate for treatment with cell therapy, said cell therapy optionally comprising a dose or composition of genetically modified cells that express a recombinant receptor; and the biological sample is obtained from the individual prior to the administration of cell therapy and / or said biological sample does not comprise the recombinant receptor and / or said modified cells; and; and (b) compare, individually, the level, quantity or concentration of the analyzed in the sample or the volumetric measurement of the tumor load with a threshold level, thus determining the risk of developing toxicity after the administration of cell therapy; and (c) following or based on the results of the assessment, administering cell therapy to the individual and, optionally, an agent or other treatment capable of treating, preventing, delaying, reducing or mitigating the development or risk of developing a toxicity.
[97]
97. Method according to any one of claims 94 to 96, characterized in that the biological sample is a blood or plasma sample.
[98]
98. Method according to any one of claims 94 to 97, characterized in that the volume measurement of the tumor load is a sum of the product dimensions (SDP) or is a volume measurement based on computed tomography and / or resonance magnetic or other body image.
[99]
99. Method according to claim 98, characterized by the fact that the volumetric measurement of the tumor load is performed before treatment, before apheresis or before the manufacture of the cellular product.
[100]
100. Method according to any one of claims 94 to 99, characterized in that it further comprises monitoring the individual for symptoms of toxicity if cell therapy is administered and is identified as having a risk of developing toxicity.
[101]
101. Method according to any one of claims 94 to 100, characterized by the fact that: the individual is at risk of developing toxicity if the level, quantity or concentration of one or more analyzed or the volume measurement of the tumor load is above a threshold level and the individual has a low risk of developing toxicity if the level, quantity or concentration, one or more analyzed or the tumor volume measurement is below a threshold level.
[102]
102. Method according to any one of claims 94 to 101, characterized by the fact that the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and / or is within a standard deviation above the median or average level, quantity or concentration, or is or is above the median or average level, quantity or concentration, of the analyzed or the volumetric measurement of the tumor load in a biological sample obtained from a group of individuals before receiving cell therapy, in which each of the individuals in the group continued to develop no toxicity after receiving a therapeutic cell composition that expresses the recombinant receptor for the treatment of the same disease or condition.
[103]
103. Method according to any of claims 94 to 102, characterized by the fact that the threshold level is within 25%, within 20%, within 15%, within 10% or within 5% and / or is within a standard deviation below the median or average level, quantity or concentration of the analyzed or the volumetric measurement of the tumor load in a biological sample obtained from a group of individuals before receiving a cell therapy, in which each of the individuals of the group developed a toxicity after receiving a recombinant drug therapeutic cell composition that expresses the receptor for the treatment of the same disease or condition.
[104]
104. Method according to any one of claims 94 to 103, characterized in that the toxicity is neurotoxicity or SLC.
[105]
105. Method according to any one of claims 94 to 104, characterized by the fact that the toxicity is neurotoxicity or SLC of grade 1 or higher.
[106]
106. Method according to any one of claims 94 to 105, characterized in that: the toxicity is severe neurotoxicity or is neurotoxicity of grade 2 or higher, neurotoxicity of grade 3 or higher, prolonged grade 3 neurotoxicity or at least prolonged or is grade 4 or 5 neurotoxicity; or the toxicity is severe SLC or comprises SLC of grade 2 or higher or 3 or higher.
[107]
107. Method according to any one of claims 94 to 106, characterized by the fact that the toxicity is neurotoxicity and the volumetric measurement of the tumor load is SDP and the one or more analyzed is selected from LDH, IL-10, IL- 15, IL-15, IL-16, TNF-a and MIP-1B.
[108]
108. Method according to any one of claims 94 to 106, characterized by the fact that toxicity is neurotoxicity and one or more analyzed are evaluated and those analyzed are selected from LDH, Ferritin, CRP, IL-6, IL-8 , IL-10, TNF-a, IFN-a2, MCP-1 and MIP-16.
[109]
109. Method according to any one of claims 94 to 106, characterized by the fact that the toxicity is neurotoxicity and one or more analyzed are evaluated and the analyzed are selected from among IL-8, IL-10 and CXCL10.
[110]
110. Method according to claim 109, characterized by the fact that neurotoxicity is severe neurotoxicity or neurotoxicity of grade 3 or higher.
[111]
111. Method according to any one of claims 94 to 106, characterized by the fact that the toxicity is SLC and one or more analytical or volumetric measures of the tumor load is selected from LDH, SPD, CRP, d-dimer, IL -6, IL-15, TNF-a and MIP-1a.
[112]
112. Method according to claim 111, characterized by the fact that the SLC is a serious SLC or a SLC of grade 3 or higher.
[113]
113. Method according to any one of claims 94 to 112, characterized in that if the individual is identified as having a risk of developing toxicity, administer to the individual: (a) (1) an agent or other treatment capable of to treat, prevent, delay, reduce or mitigate the development or risk of developing a toxicity and (2) cell therapy, where the administration of the agent must be administered (i) before, (ii) within one, two or three days later, (iii) concomitantly with and / or (iv) in the first fever after the start of administration of cell therapy to the individual; and / or (b) cell therapy at a reduced dose or at a dose that is not associated with the risk of developing serious toxicity or toxicity or that is not associated with the risk of developing severe toxicity or toxicity in most individuals and / or the majority of individuals with a disease or condition that the individual has or is suspected to have after administration of cell therapy; and / or (c) administering cell therapy to the individual in a hospital setting and / or with admission to the hospital for one or more days, optionally in which cell therapy should be administered to individuals on an outpatient basis or without admission to hospital by a or more days.
[114]
114. Method according to claim 113, characterized in that the agent or other treatment is an anti-IL-6 antibody or an anti-IL6 receptor antibody.
[115]
115. Method according to claim 114, characterized in that the agent or other treatment is or comprises an agent selected from tocilizumab, siltuximab, clazakizumab, sarilumab, olokizumabe (CDP6038), elsilimomabe, ALD5S18 / BMS-945429, sirukumabe (CNTO 136) 2634, ARGX-109, FE301 and FM101.
[116]
116. Method according to claim 113, characterized in that the agent or other treatment is or comprises a steroid, optionally dexamethasone.
[117]
117. Method according to any one of claims 94 to 107 and 113 to 116, characterized by the fact that a volumetric measure is evaluated and the volumetric measure is SDP and the threshold level is about 30 cm about 40 cm , is it about 50 cm , is it or is it about 60 cmº , or is it or is it about 70 hundred .
[118]
118. Method according to claim 117, characterized by the fact that the volumetric measure is SDP and the threshold level is or is about 50 cm .
[119]
119. Method according to any of claims 94 to 116, characterized in that the one or more analyzed is or comprises LDH and the threshold level is or is about 300 units per liter, is or is about 400 units per liter, is either about 500 units per liter or is or is about 600 units per liter.
[120]
120. Method according to claim 119, characterized by the fact that the analyzed is LDH and the threshold level is or is about 500 units per liter.
[121]
121. Method according to any one of claims 74 to 120, characterized in that the recombinant receptor specifically binds to an antigen associated with the disease or condition or expressed in the cells of the environment of an injury associated with the disease or condition.
[122]
122. Method according to any of claims 74 to 121, characterized by the fact that the disease or condition is a cancer.
[123]
123. Method according to any one of claims 74 to 122, characterized in that the disease or condition is a myeloma, leukemia or lymphoma.
[124]
124. Method according to any one of claims 74 to 123, characterized in that the disease or condition is a B-cell disease and / or is acute lymphoblastic leukemia (ALL), adult ALL, chronic lymphoblastic leukemia (LLC ), non-Hodgkin's lymphoma (NHL) and Diffuse Large B Cell Lymphoma (LDGCB).
[125]
125. Method according to any of claims 74 to 124, characterized in that the recombinant receptor is a chimeric antigen (RAQ) receptor.
[126]
126. Method according to any of claims 74 to 125, characterized in that the modified cells comprise T cells, optionally CD4 * and / or CD8 *.
[127]
127. Method according to claim 126, characterized in that the T cells are primary T cells obtained from an individual or are autologous to the individual.
[128]
128. Article of manufacture, characterized by the fact that it comprises one or more doses of a cell therapy, each dose comprising cells expressing a chimeric antigen (RAQ) receptor and instructions for administering the cell therapy, in which the instructions specify that : the cell dose should be administered to an individual with or identified as having non-Hodgkin's lymphoma (NHL), the NHL selected from diffuse large B cell lymphoma (LDGCB), primary mediastinal large B cell lymphoma (LCBMP ), NOS (again or transformed from indolent lymphoma) or Grade 3B follicular lymphoma, in which the individual is or has been identified as having an Eastern Cooperative Oncology Group Performance Status (ECOG) of 0 or 1; and the instructions specify the administration of a number of T cells or specify the administration of an amount or volume of one or more corresponding formulations or containing said specified number of cells, wherein the specified number of cells comprises between or about 5 x 107 RAQ expression T cells and 1 x 10th RAQ expression T cells, including between about 5 x 107 RAQ expression T cells and at or about 1.5 x 10º RAQ expression T cells, or about 5 x 107 RAQ expression T cells, to or about 1 x 10º RAQ expression T cells, or to or about 1.5 x 10º RAQ expression T cells, between about 2.5 x 107 T cells expressing CD8 * RAQ and at or about 5 x 10 th T cells expressing CD8 * RAQ, including between or about 2.5 x 107 T cells of RAQ expression and about 0.75 x 10 th cells T cells that express CD8 * RAQ or a or about 2.5 x 107 T cells that express CD8 * RAQ a or about 5 x 107 T cells of expression of RAQ, or at or about 0.75 x 10º T cells expressing CD8 * RAQ, or viable populations from any of the antecedents.
[129]
129. Article of manufacture according to claim 128, characterized in that the instructions specify the administration of cell therapy in a defined list of cells
CD4 * expressing the RAQ for CD8 * cells.
[130]
130. Article of manufacture characterized by the fact that it comprises a cell therapy, or one of a plurality of cell therapy compositions, comprising a dose or composition of genetically modified cells expressing a chimeric antigen receptor (RAQ) and instructions for administration cell therapy, where the instructions specify: the dose of T cells should be administered in a defined ratio of CD4 * cells expressing RAQ to CD8 * cells expressing RAQ and / or CD4 * cells to CD8 * cells, whose ratio is approximately or is 1: 1, and the cell dose should be administered to an individual with or identified as having non-Hodgkin's lymphoma (NHL), the NHL selected from diffuse large B-cell lymphoma (LDGCB ), primary mediastinal B-cell lymphoma (LCBMP), NOS (again or transformed from indolent lymphoma) or Grade 3B follicular lymphoma.
[131]
131. Article of manufacture characterized by the fact that it comprises a cell therapy, or one of a plurality of cell therapy compositions, comprising a dose or composition of genetically modified cells that express a chimeric antigen receptor (RAQ) and instructions for administration cell therapy, where the instructions specify: the cell dose should be administered to an individual with or identified as having non-Hodgkin's lymphoma (NHL), optionally an NHL selected from aggressive NHL, diffuse large B-cell lymphoma (LDGCB), NOS (again and turned into indolent), primary mediastinal large B cell lymphoma (LCBMP), lining cell lymphoma (CSF) and / or follicular lymphoma (LF), optionally Grade 3B follicular lymphoma (LF3B) ;
the dose of T cells to be administered comprises between about 5 x 107 RAQ expression T cells and 1 x 10 ° RAQ expression T cells, inclusive; and the T cell dose should be administered in a defined ratio of CD4 * cells that express the RAQ to CD8 * cells that express the RAQ and / or from CD4 * cells to CD8 * cells, the ratio of which is approximately or is 1: 1.
[132]
132. Article of manufacture according to claim 130 or 131, characterized in that the instructions further specify that cell therapy must be administered to an individual who is or has been identified as having an Eastern Cooperative Oncology Group Performance Status ( ECOG) of 0, 1 or 2 and / or which is or has been identified as having an ECOG status of O or 1.
[133]
133. Article of manufacture, according to any of claims 128 to 132, characterized by the fact that: the instructions specify that the administration of the cell dose can be performed on an outpatient basis and / or without the need for admission or overnight in a hospital.
[134]
134. Article of manufacture, according to claim 133, characterized by the fact that the instructions further specify that if, after administration of the cell dose on an outpatient basis, without the need for admission or overnight stay in a hospital, the individual will exhibit prolonged fever or fever that is either not reduced or has not been reduced by more than 1 ° C after treatment with antipyretic, the individual must be admitted to the hospital or overnight in the hospital and / or an agent or treatment should be administered for the treatment or prevention or reduction or attenuation of a neurotoxicity and / or cytokine release syndrome or risk thereof.
[135]
135. Article of manufacture, according to claim
133 or 134, characterized by the fact that the agent is or comprises an anti-IL-6 or anti-IL-6R antibody, optionally tocilizumab or siltuximab, and / or a steroid, optionally dexamethasone.
[136]
136. Article of manufacture according to any of claims 128 to 135, characterized in that it further comprises instructions for use with, after or in connection with a lymph node elimination therapy, the lymph elimination therapy —— optionally - comprising - fludarabine and / or cyclophosphamide.
[137]
137. Article of manufacture according to any of claims 128 to 136, characterized in that the article of manufacture comprises one of a plurality of cell therapy compositions comprising a first composition of genetically modified cells comprising CD4 T cells * or CD8 * T cells, where the instructions specify that the first composition is for use with a second composition comprising the other of the CD4 * T cells or CD8 * T cells, optionally in which the cells of the first composition and the cells of the same composition are from the same individual.
[138]
138. Article of manufacture according to claim 137, characterized by the fact that the instructions specify that the first composition and the second composition must be administered to a defined list of CD4 * cells that express the recombinant receptor for CD8 * cells that express the recombinant and / or CD4 * cell receptor for CD8 * cells, the ratio of which is approximately 1: 1 or is approximately 1: 3 to approximately 3: 1.
[139]
139. Article of manufacture, characterized by the fact that it comprises one or more reagents capable of detecting one or more analyzed and instructions for using the reagent to test a biological sample from an individual who is a candidate for treatment with a cell therapy, said therapy cell comprising a dose or composition of genetically modified cells expressing a recombinant receptor, in which the one or more analyzed is selected from ferritin, LDH, CXCL10, G-CSF and IL-10.
[140]
140. Article of manufacture, characterized by the fact that it comprises: a cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor, and instructions for administering the cell therapy after or based on the results of an evaluation , in a biological sample of the level, or quantity or concentration of one or more analyzed in a biological sample, said biological sample being obtained from the individual prior to the administration of the therapy cell and / or said biological sample that does not include the recombinant receptor and / or said modified cells, in which the one or more analyzed is selected from ferritin, LDH, CXCL10, G-CSF and IL-10.
[141]
141. Article of manufacture, according to claim 139 or 140, characterized by the fact that the instructions provide information on a threshold level, individually for each one or more analyzed, which is indicative of the probability of an individual to exhibit a response treatment with cell therapy.
[142]
142. Article of manufacture characterized by the fact that it comprises one or more reagents capable of detecting one or more analyzed and instructions for using the reagent to test a biological sample of an individual who is a candidate for treatment with a cell therapy, said cell therapy comprising a dose or composition of genetically modified cells that express a recombinant receptor, in which the one or more analyzed is selected from LDH, ferritin, CRP, D-dimer, SAA-1, IL-6, I1L-10, IL-15, IL-16, TNF-a, IFN-y, MIP-10, CXCL-10, IL-8, MCP-1 and MIP-1B.
[143]
143. Article of manufacture, characterized by the fact that it comprises: a cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor, and instructions for administering cell therapy after or based on the results of an evaluation , in a biological sample of the level, or quantity or concentration of one or more analyzed in a biological sample, said biological sample being obtained from the individual prior to the administration of the therapy cell and / or said biological sample that does not include the recombinant receptor and / or said modified cells, in which the one or more analyzed is selected from LDH, ferritin, CRP, D-dimer, SAA-1, IL-6, IL-10, IL-15, IL-16, TNF- a, IFN-y, MIP-10, CXCL-10, IL-8, MCP-1 and MIP-1B.
[144]
144. Article of manufacture, according to claim 142 or 143, characterized by the fact that the instructions provide information on a threshold level, individually for each one or more analyzed, which is indicative of the probability of an individual to exhibit a response durable after administration of cell therapy.
[145]
145. Article of manufacture, characterized by the fact that it comprises one or more reagents capable of detecting one or more analyzed and instructions for using the reagent to test a biological sample of an individual who is a candidate for treatment with a cell therapy, said therapy cell comprising a dose or composition of genetically modified cells that express a recombinant receptor, where the one or more analyzed is selected from LDH, Ferritin, C-reactive protein (PCR), D-dimer (fibrin degradation product), IL-6 , IL-8, IL-10, IL-15, IL-16 TNF-a, IFN-a2, MCP-1, MIP-1a and MIP-1B.
[146]
146. Article of manufacture, characterized by the fact that it comprises: a cell therapy, said cell therapy comprising a dose of genetically modified cells that express a recombinant receptor, and instructions for administering cell therapy after or based on the results of an evaluation , in a biological sample of the level, or quantity or concentration of one or more analyzed in a biological sample, said biological sample being obtained from the individual prior to the administration of the therapy cell and / or said biological sample that does not include the recombinant receptor and / or said modified cells, in which the one or more analyzed is selected from LDH, Ferritin, C-reactive protein (PCR), D-dimer (fibrin degradation product), IL-6, IL-8, I1L-10, IL-15, IL-16 TNF-a, IFN-a2, MCP-1, MIP-1a and MIP-1B.
[147]
147. Article of manufacture according to claim 145 or 146, characterized by the fact that the instructions provide information on a threshold level, individually for each of the one or more analyzed, which is indicative of the likelihood of an individual exhibiting toxicity after administration of cell therapy.
[148]
148. Article of manufacture according to any one of claims 139 to 147, characterized in that the recombinant receptor specifically binds to an antigen associated with the disease or condition or expressed in the cells of the environment of an injury associated with the disease or condition .
[149]
149. Article of manufacture according to any one of claims 139 to 148, characterized by the fact that the disease or condition is a cancer.
[150]
150. Article of manufacture according to any one of claims 139 to 149, characterized by the fact that the disease or condition is a myeloma, leukemia or lymphoma.
[151]
151. Article of manufacture according to any one of claims 139 to 150, characterized by the fact that the disease or condition is a B-cell malignancy and / or is acute lymphoblastic leukemia (ALL), adult ALL, chronic lymphoblastic leukemia (LLC), non-Hodgkin's lymphoma (NHL) and diffuse large B-cell lymphoma (LDGCB).
[152]
152. Article according to any one of claims 148 to 151, characterized by the fact that the antigen is ROR1, B cell maturation antigen (AMCB), carbonic anhydrase 9 (CAIX), teEGFR, Her2 / neu (receptor tyrosine kinase erbB2), L1I-CAM, CD19, CD20, CD22, mesothelin, CEA and hepatitis B surface antigen, antifolate receptor, CD23, CD24, CD30, CD33, CD38, CD44, EGFR, epithelial glycoprotein 2 (GEP-2), epithelial glycoprotein 40 (EPG-40), EPHa2, erb-B2, erb-B3, erb-B4, erbB, EGFR vill, folate-binding protein (FBP), FOCRLS5, FCRHB5, fetal acetylcholine receptor, GD2, GD3 , HMW-MAA, IL-22R - alpha, IL-13R-alpha2, kinase insertion domain receptor (kdr), kappa light chain, Lewis Y, L1 cell adhesion molecule, (L1- CAM), associated antigen to melanoma (MAGE) -A1, MAGE-A3, MAGE-A6, preferentially expressed melanoma antigen (AMEPE), survivin, TAG72, B7-H6, 11-13 alpha-13 receptor (IL-13Ra2), CA9, GD3 , HMW-MAA, CD171, G250 / CAIX, HLA-Al M AGE A1, HLA-A2 NY-ESO-1, PSCA, folate receptor a, CD44v6, CD44v7 / 8, integrin avb6, 8H9, NCAM, VEGF receptors, 5T4, fetal AchR, NKG2D, CD44v6 ligands, double antigen , cancer testicular antigen, mesothelin, murine CMV, mucin 1 (MUC1), MUC16, PSCA, NKG2D, NY-ESO-1, MART-1, gp100, oncofetal antigen, ROR1, TAG72, VEGF-R2, carcinoembryonic antigen (CEA), Her2 / neu, estrogen receptor, progesterone receptor, ephrinB2, CD123, c-Met, GD-2, O-acetylated GD2 (GD20), CE7, Wilms' tumor 1 (WT-1), a cyclin , cyclin A2, CCL-1, CD138, receptor coupled to the G 5D protein (RAPG5D) or a pathogen specific antigen.
[153]
153. Article of manufacture according to any one of claims 138 to 152, characterized in that the recombinant receptor is a T cell receptor or a functional non-T cell receptor.
[154]
154. Article of manufacture according to any one of claims 138 to 153, characterized by the fact that the recombinant receptor is a chimeric antigen (RAQ) receptor.
[155]
155. Article of manufacture according to any one of claims 128 to 154, characterized by the fact that: the RAQ comprises an antigen-specific scFv, a transmembrane domain, a cytoplasmic signaling domain derived from a costimulatory molecule, which optionally is or comprises a 4-1BB, and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which optionally is or comprises a CD3zeta signaling domain and optionally further comprises a spacer between the transmembrane domain and the scFv; the RAQ comprises, in order, an antigen-specific scFv, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulatory molecule, which optionally is or comprises a 4-1BB signaling domain and a cytoplasmic signaling domain derived from a molecule containing primary signaling ITAM, which optionally is a CD3zeta signaling domain; or the RAQ comprises, in order, an antigen-specific scFv, a spacer, a transmembrane domain, a cytoplasmic signaling domain derived from a co-stimulating molecule, which optionally is a 4-1BB signaling domain and a cytoplasmic signaling domain a primary signaling molecule containing ITAM, which optionally is or comprises a CD3zeta signaling domain; and where:
the spacer is a polypeptide spacer that (a) comprises or consists of all or a portion of an immunoglobulin joint or a modified version thereof or comprises about 15 amino acids or less and does not comprise an extracellular region of CD28 or an extracellular region of CD8, (b) comprises or consists of all or a portion of an immunoglobulin joint, optionally an IgG4 joint, or a modified version of it and / or comprises about amino acids or less, and does not comprise an extracellular region of CD28 or an extracellular region of CD8, or (c) is 12 or approximately amino acids in length and / or comprises or consists of all or a portion of an immunoglobulin joint, optionally an IgG4 or a modified version thereof; or (d) has or consists of the sequence of SEQ ID NO: 11, a sequence encoded by SEQ ID NO: 2, SEQ ID NO: 30, SEQ ID NO: 31, SEQ ID NO: 31, SEQ ID NO: 32, SEQ ID NO: 33, SEQ ID O: N 34, or a variant of any of the previous items having at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93% , 94%, 95%, 96%, 97%, 98%, 99% or more of sequence identity, or (e) comprises or consists of the formula XIPPX2P, where X1 is glycine, cysteine or arginine and X it is cysteine or threonine; and / or the co-stimulatory domain comprises SEQ ID NO: 12 or a variant thereof with at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94% , 95%, 96%, 97%, 98%, 99% or more of sequence identity; and / or the primary signaling domain comprises SEQ ID NO: 13 or 14 or 15 with at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94 %, 95%, 96%, 97%, 98%, 99% or more of sequence identity; and / or scFfv comprises a CDRL1 sequence of RASQDISKYLN (SEQ ID NO: 35), a CDRL2 sequence of SRLHSGV (SEQ ID NO: 36) and / or a CDRL3 sequence of GNTLPYTFG (SEQ ID NO: 37) and / or a DYGVS CDRH1 sequence (SEQ ID NO: 38) a VIWGSETTYYNSALKS CDRH2 sequence (SEQ ID NO: 39) and / or a YAMDYWG CDRH3 sequence (SEQ ID NO: 40) or where the scFv comprises a variable region of the FMC63 heavy chain and a variable region of the FMC63 light chain and / or a CDRL1 sequence of FMC63, a sequence of CDRL2 of FMC63, a sequence of CDRL3 of FMC63, a sequence of CDRH1 of FMC63, a sequence of CDRH2 of FMC63 and a sequence of CDRH3 of FMC63 either binds to the same epitope that either competes for binding with any of the above, and optionally where scFv comprises, in order, a VH, a linker, optionally comprising SEQ ID NO : 24, and a VL, and / or scFv comprises a flexible linker and / or comprises the amino acid sequence established as SEQ ID N O: 24.
[156]
156. Article of manufacture, according to claim 155, characterized by the fact that the antigen is a B cell antigen, which is optionally CD19.
[157]
157. Article of manufacture according to any one of claims 128 to 156, characterized in that the modified cells comprise T cells, optionally CD4 * and / or CD8 ”*.
[158]
158. Article of manufacture, according to claim 157, characterized by the fact that T cells are primary T cells obtained from an individual.

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同族专利:

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公开号 | 公开日

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RU2019144333A|2021-07-09|

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EP3630132A1|2020-04-08|

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KR20200054160A|2020-05-19|

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US20200147136A1|2020-05-14|

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CN111225675A|2020-06-02|

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IL270982D0|2020-01-30|

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CA3065120A1|2018-12-06|

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JP2020522489A|2020-07-30|

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AU2018275894A1|2019-12-12|

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WO2018223101A1|2018-12-06|

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PH12019502661A1|2020-06-08|

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法律状态:
2021-11-03| B350| Update of information on the portal [chapter 15.35 patent gazette]|

优先权:

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申请号 | 申请日 | 专利标题

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US201762514774P| true| 2017-06-02|2017-06-02|

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US62/514,774|2017-06-02|

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US201762515530P| true| 2017-06-05|2017-06-05|

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US62/515,530|2017-06-05|

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US201762521366P| true| 2017-06-16|2017-06-16|

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US62/521,366|2017-06-16|

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US201762527000P| true| 2017-06-29|2017-06-29|

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US62/527,000|2017-06-29|

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US201762549938P| true| 2017-08-24|2017-08-24|

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US62/549,938|2017-08-24|

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US201762580425P| true| 2017-11-01|2017-11-01|

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US62/580,425|2017-11-01|

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US201762593871P| true| 2017-12-01|2017-12-01|

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US62/593,871|2017-12-01|

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US201762596764P| true| 2017-12-08|2017-12-08|

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US62/596,764|2017-12-08|

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US201862614957P| true| 2018-01-08|2018-01-08|

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US62/614,957|2018-01-08|

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PCT/US2018/035755|WO2018223101A1|2017-06-02|2018-06-01|Articles of manufacture and methods for treatment using adoptive cell therapy|

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